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J Invest Dermatol. 2018 Apr;138(4):785-794. doi: 10.1016/j.jid.2017.11.015. Epub 2017 Nov 26.

Intentional and Unintentional Medication Non-Adherence in Psoriasis: The Role of Patients' Medication Beliefs and Habit Strength.

Author information

1
Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Dermatology Research, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK. Electronic address: Rachael.Thorneloe@manchester.ac.uk.
2
Centre for Dermatology Research, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK; Salford Royal Hospital NHS Foundation Trust, Salford, UK; Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK.
3
Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
4
Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
5
Division of Musculoskeletal and Dermatological Sciences, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK.

Abstract

Medication non-adherence is a missed opportunity for therapeutic benefit. We assessed "real-world" levels of self-reported non-adherence to conventional and biologic systemic therapies used for psoriasis and evaluated psychological and biomedical factors associated with non-adherence using multivariable analyses. Latent profile analysis was used to investigate whether patients can be categorized into groups with similar medication beliefs. Latent profile analysis categorizes individuals with similar profiles on a set of continuous variables into discrete groups represented by a categorical latent variable. Eight hundred and eleven patients enrolled in the British Association of Dermatologists Biologic Interventions Register were included. Six hundred and seventeen patients were using a self-administered systemic therapy; 22.4% were classified as "non-adherent" (12% intentionally and 10.9% unintentionally). Patients using an oral conventional systemic agent were more likely to be non-adherent compared to those using etanercept or adalimumab (29.2% vs. 16.4%; P ≤ 0.001). Latent profile analysis supported a three-group model; all groups held strong beliefs about their need for systemic therapy but differed in levels of medication concerns. Group 1 (26.4% of the sample) reported the strongest concerns, followed by Group 2 (61%), with Group 3 (12.6%) reporting the weakest concerns. Group 1 membership was associated with intentional non-adherence (odds ratio = 2.27, 95% confidence interval = 1.16-4.47) and weaker medication-taking routine or habit strength was associated with unintentional non-adherence (odds ratio = 0.92, 95% confidence interval = 0.89-0.96). Medication beliefs and habit strength are modifiable targets for strategies to improve adherence in psoriasis.

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