Barriers to medication adherence in a rural-urban dual economy: a multi-stakeholder qualitative study

BMC Health Services Research

Mengxi Zhao¹  Yilong Wang²  Yongjun Wang²  Yuesong Pan²  Liping Liu²  Janet Prvu Bettger³  Noelle Wyman Roth⁴  Han Zhang⁵  Chunxi Ding⁵  Jacqueline Xu⁵  Chelsea Liu⁶  Athina Vrosgou⁷  Natalie Chin Wen Yu⁸ 

[1] Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China;China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China;Department of Orthopaedics, Duke University School of Medicine, Durham, NC, USA;Duke Global Health Institute, Duke University, Durham, NC, USA;Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA;Social Science Research Institute, Duke University, Durham, NC, USA;Trinity College of Arts and Sciences, Duke University, Durham, NC, USA;Trinity College of Arts and Sciences, Duke University, Durham, NC, USA;Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA;Trinity College of Arts and Sciences, Duke University, Durham, NC, USA;Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK;Trinity College of Arts and Sciences, Duke University, Durham, NC, USA;Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA;

关键词: Developing Countries;    Medication Adherence;    Noncommunicable Diseases;    Qualitative Research;    Stroke;   

DOI  :  10.1186/s12913-021-06789-3

来源: Springer

【 摘 要 】

BackgroundOne of the most cost-effective treatments for secondary prevention of stroke and other non-communicable diseases is a long-term medication regimen. However, the complexities of medication adherence extend far beyond individual behavior change, particularly in low- and middle-income countries. The purpose of this study was to examine stakeholder perspectives on barriers to medication adherence for stroke patients in Beijing, China, identifying opportunities to improve care and policy in resource-constrained settings.MethodsWe conducted a qualitative, phenomenological analysis of data obtained from 36 individuals. Participants were patients; caregivers; healthcare providers; and representatives from industry and government, purposively selected to synthesize multiple perspectives on medication management and adherence for stroke secondary prevention in Beijing, China. Data was analyzed by thematic analysis across iterative coding cycles.ResultsFour major themes characterized barriers on medication adherence, across stakeholders and geographies: limitations driven by individual patient knowledge / attitudes; lack of patient-provider interaction time; lack of coordination across the stratified health system; and lack of affordability driven by high overall costs and limited insurance policies.ConclusionsThese barriers to medication management and adherence suggest opportunities for policy reform and local practice changes, particularly for multi-tiered health systems. Findings from this study in Beijing, China could be explored for applicability in other low- and middle-income countries with urban centers serving large geographic regions.

【 授权许可】

CC BY