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Prevalence of Adherence to Treatment in Homebound Elderly People in Primary Health Care

A Descriptive, Cross-Sectional, Multicentre Study

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Abstract

Background Adherence to the therapeutic plan is one of the most important health issues in terms of treatment efficacy, healthcare costs and patient safety. Unfortunately, homebound elderly patients are especially vulnerable to nonadherence because they have higher morbidity rates combined with cognitive and social problems that hinder their correct use of drugs. The level of therapeutic adherence in homebound elderly people has not been adequately studied.

Objective To estimate the prevalence of therapeutic adherence, using the Morisky-Green test, in homebound elderly patients taking polypharmacy (defined as use of four or more drugs), and to study the factors associated with adherence.

Methods This was a descriptive, cross-sectional, multicentre study. A total of 327 patients were selected by random start systematic sampling from the total number of homebound patients taking four or more drugs in Healthcare Area 4 of the Madrid Autonomous Region, Spain. Through an in-home survey of patients and their caregivers, information was gathered on sociodemographic data, co-morbidities, number of hospital admissions, responsibility for purchasing and preparation of the medication, level of cognitive impairment (Pfeiffer questionnaire), functional dependence in activities of daily living (Katz Index), knowledge of the disease (Batalla test), adherence to treatment (Morisky-Green test), visual and auditory perception, and caregiver burden (Zarit interview).

Results Of the homebound patients, 65.7% (95% CI 60.6, 70.9) had good adherence to treatment. The variables most negatively associated with therapeutic adherence, after adjustment for age, sex, number of drugs, knowledge of the disease, and cognitive function, were a large caregiver burden (odds ratio [OR] 3.09; 95% CI 1.75, 5.48) and impaired hearing (OR 2.00; 95% CI 1.17, 3.40). There was also a trend toward a positive association between nonadherence and patients aged >85 years (OR 1.57; 95% CI 0.93, 2.65) and patients who had nine or more drug prescriptions (OR 1.59; 95% CI 0.96, 2.65).

Conclusions Poor therapeutic adherence in homebound elderly patients receiving polypharmacy is a serious problem affecting one of every three individuals concerned, and is directly related to caregiver burden, regardless of age, sex, cognitive status or number of drugs administered.

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Acknowledgements

No sources of funding were used to assist in the conduct of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

PATER Group (Prevalence of Adherence to Treatment in homebound EldeRly people in primary health care): Oriana Ramirez Rubio, Carmen Mure Calmaestra, Ana Belén Ramírez Puerta, Carmen Calvo Torres, Eva María Gómez Robledo, Yolanda Maestre Casadomet, Carmen Ceruelo Nieves, Mónica Igea Moreno, Ana Belén Moreno Moreno, Marcos López Martínez, Miriam Castro Benito, Matilde Jordan Martín, María Lorena Rodríguez Pérez, Marta Maestre Casadomet, Margarita Camarero Shelly, María Jesús Clemente del Castillo, Begoña Fernández Herrero, Alicia Marín García, Carmen Pérez-Pellón Montero, María Isabel García del Río, María José Hernández Yela, Raquel Masa Pacheco, Susana García Carmona, Ascensión Delgado López, Ana Belén Paredes Pérez, Javier Rando Caño, Pilar Peinado López, Concepción Antelo Brioso, Miriam Aquesihualpa Hualpa, María Nieves del Castillo Roldán, Isabel Careaga Gónzalez, Susana Herrero Yusta, Sonsoles Sastre Páez, Esther Cruz Almarza, Carmen Cristobal Martínez, Juan Manuel García Ruiz, Yolanda Vázquez Martín, Pilar del Dedo Torre, Antonia Delgado Camacho.

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Authors and Affiliations

  1. Unidad de Sistemas de Información, Gerencia Área 4 de Atención Primaria, SERMAS, C/Doctor Cirajas, 20, 28017, Madrid, Spain

    Juan Cárdenas-Valladolid

  2. Unidad de Formación e Investigación, Área 4 de Atención Primaria, SERMAS, Madrid, Spain

    Carmen Martín-Madrazo, Enrique Carrillo de-Santa Pau, Juan C. Abánades-Herranz & Carmen de Burgos-Lunar

  3. Fundación Investigación Biomedica, Hospital Carlos III, Madrid, Spain

    Miguel A. Salinero-Fort

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  1. Juan Cárdenas-Valladolid
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Correspondence to Juan Cárdenas-Valladolid.

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Cárdenas-Valladolid, J., Martín-Madrazo, C., Salinero-Fort, M.A. et al. Prevalence of Adherence to Treatment in Homebound Elderly People in Primary Health Care. Drugs Aging 27, 641–651 (2010). https://doi.org/10.2165/11537320-000000000-00000

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