First Things First: Difficulty with Current Medications is Associated with Patient Willingness to Add New Ones

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Background:Inadequate BP control remains prevalent. One proposed explanation is ‘clinical inertia,’ often defined as the failure by providers to initiate or intensify medication therapy when otherwise appropriate. However, patients could contribute to clinical inertia by signaling an unwillingness to consider medication intensification.Objective:To explore co-variates of patient attitudes likely to predict patients' willingness to intensify (WTI) their medication regimen.Methods:A cross-sectional survey was conducted in nine Midwestern US Veterans' Administration medical facilities as part of a prospective cohort study of clinical inertia in hypertension treatment. 1062 patients with diabetes mellitus, identified as having BP ≥140/90 mmHg, were surveyed. Primary outcome was participants' indicated WTI BP medications if their provider noted elevated BP levels. Potential co-variates assessed included BP control (actual and perceived), perceived importance of BP control, BP management self-efficacy, competing demands, medication factors (adherence and management issues), trust in provider, and sociodemographic factors.Results:While 64% of participants reported complete WTI BP medications, 36% of participants expressed at least some unwillingness. In ordered logistic regression analysis, WTI was negatively associated with medication concerns, particularly concern about adverse effects (odds ratio [OR] 0.49; 95% CI 0.42, 0.59) and adherence or management problems (OR 0.72; 95% CI 0.57, 0.91), and positively associated with perceived dependence of health on BP medications (OR 1.50; 95% CI 1.26, 1.79) and trust in provider (OR 1.30; 95% CI 1.10, 1.54). Importance of BP control had a weaker, nonsignificant association with WTI (OR 1.17; 95% CI 0.99, 1.40). Competing demands, current BP control, current number of medications prescribed, and self-efficacy were not associated with WTI medications.Conclusions:Patients' willingness to consider intensification of BP medications appears primarily determined by how well patients are managing their current medications, rather than patients' perceived importance of BP control, their self-efficacy, or their prioritization of BP control versus other health demands. Greater attention to patients' pre-existing medication issues may improve providers' ability to intensify BP medication therapy when medically appropriate while simultaneously improving patient satisfaction with care.

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