All ETDs from UAB

Advisory Committee Chair

Emily B Levitan

Advisory Committee Members

April P Carson

Thomas N Creger

Monika M Safford

Janet M Turan

Document Type

Dissertation

Date of Award

2018

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Barriers of medication adherence exist among people with coronary heart disease (CHD) and CHD risk factors, including, poor social support, poor pharmacy access and other patient, social/economic, therapy, condition, and health-care system/health-care team-related factors. However, there are few data on influence of these factors on medication adherence among people with CHD risk factors other than diabetes. Therefore, this dissertation aimed to investigate associations of medication adherence with social support (n=17,113) and pharmacy access (n=8,250) quantitatively using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (black and white adults with CHD or CHD risk factors ≥45 years of age assessed 2003-2007 and ≥52 years of age assessed 2013-2016, respectively) and to obtain patient perspectives on how patient, social/economic, therapy, condition, and health-care system/health-care team-related factors influence medication adherence, through in-depth qualitative interviews of patients recruited from University of Alabama at Birmingham clinics (n=18). In REGARDS, medication adherence was self-reported. Social support was defined as having a caregiver in case of sickness or disability, being partnered, number of: close friends, close relatives, other adults in household, and close friends or relatives seen at least monthly. Participants who saw >10 close friends or relatives at least monthly had higher prevalence of medication adherence (PR=1.06; 95% CI: 1.00, 1.11) than those who saw <3 monthly. There were no other significant associations between social support measures and medication adherence. Pharmacy location data were obtained from National Council for Prescription Drug Programs. Pharmacy access was defined as straight-line distances from REGARDS participants’ residences to nearest pharmacy and number of pharmacies within 1.61, 8.1, 16.1 and 24.1 km radii from participants’ residences. Pharmacy access measures were not associated with medication adherence. Four themes emerged from the qualitative data: perceived need for medication, beliefs about medications, influence of relationships with people and organizations and influence of pharmacy access and utilization on medication adherence. These occurred simultaneously and within context of patient, social/economic, therapy, condition and health-care system/health-care team-related factors. In conclusion, multidimensional interventions targeted at these factors, including social support, may help improve medication adherence among people with CHD and CHD risk factors.

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