James K. Cooper

Intentional Prescription Nonadherence (Noncompliance) by the Elderly

Prescription drugs are not always taken as directed. When there is a discrepancy between the use of a drug and the prescription directions, the drug‐taking behavior is considered “nonadherent.” To determine the extent of prescription nonadherence by old persons and the reasons for nonadherence, an in‐home survey was made of 111 elderly subjects who were taking prescription drugs. Drug‐taking behavior was compared with the behavior implied by the prescription instructions, and reasons for the differences were sought. Of the study sample, 43 per cent showed such differences in use of one or more prescription drugs. The chief type of discrepancy was underuse (90 per cent of nonadherence). No difference was observed in most of the psychosocial variables studied between those who took drugs as directed and those who did not. Hypertensive subjects did not differ from those without hypertension. A large proportion of nonadherence (73 per cent) was intentional. Intentional nonadherence was more likely to occur in subjects who used two or more pharmacies and two or more physicians. Traditional efforts aimed at reducing the incidence of forgetting to take medicines would not seem to be helpful in cases of intentional nonadherence.

Physician shortage in Kentucky, 1930-1980.

Changes in the number and locations of Kentucky counties with a shortage of physicians (using current federal definitions of medical underservice) were examined for the decennial years 1930 to 1980. The number of counties with a physician shortage were found to have increased from four per cent in 1930 to 20 per cent in 1970 and 1980. The per cent of population in physician shortage counties was also found to have increased between 1930 and 1970, but to have declined slightly by 1980. Differences in the average population-to-physician ratios of Appalachian and non-Appalachian counties were significant for every year except 1980.