Is forgetting your pills really just an accident?
Forgetting or running out of chronic medication was very common and was predicted by people's beliefs about needing and affording the drug, so it is not purely accidental.
Source
Unintentional non-adherence to chronic prescription medications: how unintentional is it really?
Study at a glance
- Design
- Cross-sectional — Online survey of a chronic-illness panel; logistic regression and bootstrapped mediation analysis
- N
- N=24017 · 24,017 self-identified medication persisters from 51,774 screener completers
- Population
- US adults aged 40+ on medication for hypertension, hyperlipidemia, diabetes, asthma, osteoporosis or depression
- Outcome
- Self-reported unintentional non-adherence (forgetting, running out, carelessness) and intentional non-adherence over six months
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
The authors surveyed adults aged 40 and over from an internet chronic-illness panel who said they were still taking a prescription medicine for one of six common conditions. Respondents reported whether, in the past six months, they had forgotten doses, run out, or been careless, and whether they had deliberately changed or skipped doses. They also rated their perceived need for the medicine, their concerns about it, and its affordability, and the researchers tested whether unintentional non-adherence links those beliefs to intentional non-adherence.
What they found
70% reported at least one unintentional non-adherence behaviour, most often forgetting (62%), and about a third reported intentional non-adherence. Lower perceived need, more concerns and especially lower affordability predicted unintentional non-adherence; those in the lowest affordability quartile were 2.32 times more likely to report it than those in the highest. Younger people were more affected, and mediation analysis suggested beliefs influence intentional non-adherence partly through unintentional non-adherence.
The limits
What it doesn't show
The design is cross-sectional, so the proposed chain from beliefs to unintentional to intentional non-adherence is not established in time; the authors call for longitudinal confirmation. Adherence was self-reported as yes/no without frequency and was not checked against pharmacy records. The internet panel had a 29.5% contact rate and over-represented white, higher-income and more educated respondents.
Key terms
- Unintentional non-adherence
- Missing medication passively, e.g. forgetting, running out or being careless, rather than by choice.
- Intentional non-adherence
- Deliberately skipping, reducing or stopping medication, for example to make it last longer.
- Medication persister
- Someone who reports still being on their prescribed therapy rather than having stopped it.
- Mediation analysis
- A test of whether the effect of one variable on an outcome passes through an intermediate variable.
- Bootstrapping
- Repeatedly resampling the data to estimate a confidence interval without assuming a normal distribution.
Flashcards
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Quiz yourself
What was the most commonly reported unintentional non-adherence behaviour?
Common questions
If people forget because of beliefs, is it still 'unintentional'?
The paper argues the label is misleading: forgetting is patterned by how much people value and can afford the drug, so interventions should address beliefs, not just reminders.
Why were people who stopped their medication excluded?
Completely discontinuing a drug cannot logically be unintentional, so only current persisters were analysed.
Why might the 70% figure be higher than other studies?
The question asked whether the behaviour ever happened in six months, which catches occasional lapses that other wordings miss.
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