Journal Article

Social support, social context and nonadherence to treatment in young senior patients with multimorbidity and polypharmacy followed-up in primary care. MULTIPAP Study

Calderón-Larrañaga, Amaia, Poblador-Plou, Beatriz, Leiva-Fernández, Francisca, Cura-González, Isabel del, Lozano-Hernández, Cristina M., López-Rodríguez, Juan A., Barrio-Cortes, Jaime, Gimeno-Feliu, Luis A.

2020

Overview

To estimate the prevalence of nonadherence to treatment and its relationship with social support and social context in patients with multimorbidity and polypharmacy followed-up in primary care. This was an observational, descriptive, cross-sectional, multicenter study with an analytical approach. A total of 593 patients between 65-74 years of age with multimorbidity (≥3 diseases) and polypharmacy (≥5 drugs) during the last three months and agreed to participate in the MULTIPAP Study. The main variable was adherence (Morisky-Green). The predictors were social support (structural support and functional support (DUFSS)); sociodemographic variables; indicators of urban objective vulnerability; health-related quality of life (EQ-5D-5L-VAS & QALY); and clinical variables. Descriptive, bivariate and multivariate analyses with logistic regression models and robust estimators were performed. Four out of ten patients were nonadherent, 47% had not completed primary education, 28.7% had an income ≤1050 €/month, 35% reported four or more IUVs, and the average perceived health-related quality of life (HRQOL) EQ-5D-5L-VAS was 65.5. The items that measure functional support, with significantly different means between nonadherent and adherent patients were receiving love and affection (-0.23; 95%CI: -0.40;-0.06), help when ill (-0.25; 95%CI: -0.42;-0.08), useful advice (-0.20; 95%CI: -0.37;-0.02), social invitations (-0.22; 95%CI:-0.44;-0.01), and recognition (-0.29; 95%CI:-0.50;-0.08). Factors associated with nonadherence were belonging to the medium vs. low tertile of functional support (0.62; 95%CI: 0.42;0.94), reporting less than four IUVs (0.69; 95%CI: 0.46;1.02) and higher HRQOL perception (0.98; 95%CI: 0.98;0.99). Among patients 65-74 years of age with multimorbidity and polypharmacy, lower functional support was related to nonadherence to treatment. The nonadherence decreased in those patients with higher functional support, lower urban vulnerability and higher perceived health status according to the visual analog scale of health-related quality of life.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Aged / Behavior / Bivariate analysis / Chronic illnesses / Comorbidity / Context / Cross-Sectional Studies / Drug Monitoring / Drug therapy / Elderly patients / Female / Follow-Up Studies / Health aspects / Health care / Health sciences / Health services / Humans / Male / Medicine and Health Sciences / Multimorbidity / Neurosciences / Older people / Outcome Assessment, Health Care - methods / Outcome Assessment, Health Care - statistics & numerical data / Patient compliance / Patient outcomes / Patients / Physical Sciences / Polypharmacy / Prevalence / Primary care / Primary health care / Primary Health Care - methods / Primary Health Care - statistics & numerical data / Public health / Quality of life / Questionnaires / Regression analysis / Regression models / Research and Analysis Methods / Robustness (mathematics) / Social Environment / Social interactions / Social networks / Social Sciences / Social Support / Socioeconomic Factors / Spain - epidemiology / Statistics / Structure-function relationships / Studies