non-concordance with medication: a multilevel analysis

Background: Non-concordance with medication remains a major public health problem that imposes a considerable financial burden on the health care system, and there is still a need for studies on correlates of non-concordance. Our first aim is to analyse whether any of the individual characteristics age, educational level, financial strain, self-rated health, social participation, and trust in the health care system are associated with primary non-concordance with medication. Our second aim is to investigate whether people living in the same area have similar probability of primary non-concordance with medication, that relates to area social participation. Methods: We analysed cross sectional data from 9 070 women and 6 795 men aged 18 to 79 years, living in 78 areas in central Sweden, who participated in the Life & Health year 2000 survey, with multilevel logistic regression (individuals at the first level and areas at the second level). Results: Younger age, financial strain, low self-rated health, and low trust in the health care system were associated with primary non-concordance with medication. However, area social participation was not related to primary non-concordance, and the variation in primary nonconcordance between the areas was small. Conclusion: Our results indicate that people in central Sweden with younger age, financial difficulties, low self-rated health, and low trust in the health care system may have a higher probability of primary non-concordance with medication. However, the area of residence – as defined by administrative boundaries – seems to play a minor role for primary non-concordance. Background Patients' concordance with medication is a prerequisite for effective drug therapy. Non-concordance is a major public health problem that imposes a considerable financial burden on the health care system [1,2]. Despite the comprehensive research on concordance during the last decades [3], non-concordance remains a concern in health care, and there is still a need for studies on correlates of non-concordance because the complex phenomenon of non-concordance is far from understood. It has Published: 02 March 2006 BMC Public Health2006, 6:52 doi:10.1186/1471-2458-6-52 Received: 24 October 2005 Accepted: 02 March 2006 This article is available from: http://www.biomedcentral.com/1471-2458/6/52 © 2006Johnell et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.