Background: Adherence to medication for osteoporosis is suboptimal, resulting in increased morbidity, untimely mortality and increased costs. About 50% of patients discontinue medication too early or forget to take their pills. Moreover, about 30% of patients do not even start taking medication. Little is known about these patients with so-called intentional non-adherence. The objective was to explore factors and considerations related to intentional non-adherence in patients and family physicians (FPs).
Methods: Qualitative, grounded theory. Semi-structured interviews patients who decided not to start treatment and their family physicians. Interviews were performed until saturation was reached. Two researchers independently analysed the interviews and categorised factors. Primary care setting. Patients who have been advised by their FP to take bone sparing medication after being diagnosed with osteoporosis but did not do so. FPs who have given the treatment advice were also interviewed. Inclusion criteria: willingness to participate. There were no exclusion criteria. Intervention/instrument: Semi-structured interviews. Main and secondary outcome measures: Factors related to intentional non-adherence from patients and doctors perspectives.
Results: 19 patients and 13 FPs were interviewed. The following main themes have been identified in patients: 1. Unwillingness to take medication to prevent age related health hazards. 2. Fear of side effects of drugs in general. 3. Mistrust in bisphosphonates. 4. Overestimation of their own health condition. 5. Underestimation of consequences of osteoporosis. 6. Perceived ambiguous communication by the FP. 7. Miscommunication or insufficient understanding of the advice given by the FP. FP results: Insufficient knowledge and unfamiliarity with the disease and its treatment to be able to motivate the patient. Reservation of the FP about bisphosphonate treatment. General animosity of the patient towards medication. Fear of side effects. Underestimation of the consequences of osteoporosis. Prioritisation by the patient.
Disclosure: The authors declared no competing interests. This work was funded by Stichting Achmea Gezondheidszorg; Takeda (The Netherlands); and Amgen (The Netherlands).