Recent estimates indicate that 21 million US adults live with Type II Diabetes Mellitus (T2DM). The management of the condition often requires patients to take multiple prescription medications to prevent disease progression; yet prescribed regimens themselves can become burdensome. Studies have shown that for patients with T2DM, the average regimen size ranges between four and ten chronic, daily medications. Since individuals with T2DM are also likely to have other comorbid chronic conditions, such as hypertension and hyperlipidemia, self-management can be quite complex.To achieve the greatest therapeutic benefit from medications, patients with T2DM need to maintain a high level of adherence. This requires sufficient cognitive skills to organize how and when medications are taken in a consistent manner. Thus, the complexity of medication-related tasks can be formidable, arising from the sheer number of medications, the frequency of doses daily each is to be taken, route of administration, and many other facets. As regimen complexity increases, so does the risk a patient may unintentionally misuse a medication leading to harm or inadequate adherence leading to suboptimal treatment benefits. Prior studies have suggested patients with limited health literacy may be particularly at risk of making dosing errors and overcomplicating medication regimens. Most of the evidence to date has studied medication-taking behaviors in hypothetical scenarios, as opposed to examining how patients organize and dose their actual medication regimens. Thus, little is known about how lower health literate, community dwelling adults living with T2DM and other chronic conditions dose their daily medications and the frequency of unintentional dosing errors. Also unknown are which, if any, demographic or psychosocial factors (e.g., mental health, patient activation, social support) are associated with difficulty managing overly complex dosing patterns. Nonadherence and unintentional misuse of medications place patients at risk of subtherapeutic benefit and worsened clinical outcomes such as hypoglycemia. Complex regimens are also associated with preventable medication errors that can lead to adverse drug events. Patients with undertreated T2DM are at risk of serious health consequences such as heart attack or stroke. If patients with T2DM are found to have high levels of regimen complexity, then interventions tailored toward simplifying complex regimens or increasing additional support for patients with complex regimens would be an important pathway to reducing preventable negative outcomes. However, very few studies have examined the relationship between robust definitions of regimen complexity and diabetes outcomes. In this dissertation, I conducted three studies using data collected from two parent studies of community dwelling adults with T2DM taking multiple medications. The first and second studies were conducted among a traditionally underserved population, primarily lower income, Hispanic participants with low health literacy. The first study described the relationship between age and limited English proficiency with regimen knowledge, dosing overcomplication, and dosing errors. The second study examined the association between the previously validated medication regimen complexity index (MRCI) and hemoglobin A1C. Finally, the third study explored the relationship between psychosocial determinants of health with perceived barriers to adherence among patients with polypharmacy. Results from these studies revealed that one in five patients from traditionally underserved backgrounds overcomplicated the daily dosing of their medication regimens. Larger regimen size was associated with increased risk of dosing overcomplication and worse regimen knowledge, while limited English proficiency was associated with increased risk of dosing errors. Regimen complexity, as measured by the MRCI across the entire medication regimen, was associated with higher A1C. Among patients contending with multimorbidity and polypharmacy, depression, poor health activation, and low levels of social support predicted increased barriers of adherence. In summary, patients with multimorbidity and polypharmacy contend with significant skill-based and psychosocial barriers affecting their adherence and control of their diabetes. For interventions aimed at improving adherence and outcomes among complex patients to be effective, opportunities should be sought in clinical practice to routinely monitor how patients actually take their multi-drug regimens to ensure safe use, as well as to be aware of certain risk factors that may also adversely distract from proper dosing.

Creator

• Russell, Andrea M

DOI

• https://doi.org/10.21985/n2-1h22-ww11

Subject

• Clinical psychology

Language

• en

Alternate Identifier

• etdadmin_upload_828323
• http://dissertations.umi.com/northwestern:15614

Date created

• 2021-01-01

Resource type

• Dissertation

Rights statement

• In Copyright