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Primary Medication Adherence in a Rural Population: The Role of the Patient-Physician Relationship and Satisfaction with Care

Departments of Family Medicine and Social Medicine (THW); University of North Carolina at Chapel Hill
Cecil G. Sheps Center for Health Sciences Research and Department of Family Medicine (DEP), University of North Carolina at Chapel Hill

Correspondence: Corresponding author: Thomas H. Wroth, MD, MPH, Department of Family Medicine, University of North Carolina at Chapel Hill, Campus Box 7595, Chapel Hill, NC 27599 (E-mail: thomas_wroth{at}med.unc.edu)

Introduction: Although correlates of overall medication adherence have been studied, little is known about primary medication non-adherence—patients’ failing to fill a prescription provided by a practitioner—and whether it relates to how patients view their physician, satisfaction with their care, and how easy or hard it is for them to travel for care.

Methods: This study uses telephone survey data from adults in 150 rural counties in 8 southeastern states. Bivariate and multivariable analyses were used to identify factors associated with adults’ self-reports of delaying or not filling prescriptions.

Results: Of the 3926 respondents who had received care in the previous year, 894 (21.6%) reported that they had delayed or did not fill a prescription over that time. In multivariate analysis, delaying or not filling prescriptions was more common among respondents who were under age 65, African American, reported incomes less than $25,000, and reported fair or poor health. Non-adherence was also more common among patients who reported transportation problems, a lack of confidence in their doctor’s ability to help them, a lack of satisfaction with the concern shown them by their physicians, and a lack of satisfaction with how welcome and comfortable they are made to feel by office staff.

Conclusions: Prescription primary non-adherence is prevalent in the rural South. Adherence may be improved by remedying patient dissatisfaction and lack of confidence in their physicians as well as addressing transportation barriers.