Moderating effects of occupational health exposures and medication adherence: models for improved adherence

Medication adherence is of great public health importance as medication non-adherence greatly affects chronic disease burden and total healthcare spending. This prospective research study hypothesizes the relationship between occupational factors and health behaviors by examining the theoretical link between medication adherence and job strain as characterized by an individual’s physical and psychological stressors. Such physical and psychological stressors can impact a worker’s confidence in his/her ability to exert control over his/her own motivation, behavior, and social environment (viz., self-efficacy) – factors that ultimately impact medication adherence. The study examines the association between job type and medication adherence in a population of individuals with diabetes and cardiovascular disease (CVD). Participants with a new or existing prescription for oral medications to treat diabetes or hyperlipidemia were enrolled into a randomized controlled trial at 34 national chain drugstores in Tennessee. Participants received standard care or a Screening and Brief Intervention (SBI) and a pillbox at the initial prescription fill, and at each additional refill, provided by a pharmacist. Medication adherence, health care utilization, psychosocial assessment, chronic disease status, and occupational health history data were obtained from the participants. Participants were then stratified by job class and job strain. Job class was classically defined, while the Karasek demand-control model was used to characterize job strain. The Karasek model describes two components of working life that influence job strain. The first is the psychological demands of the job and the second is a worker’s ability to use skills or authority to address those demands. Understanding this relationship can provide insight into the development of workplace disease prevention and wellness programs that target employees who are at increased risk for poor medication adherence as well as provide new insight to healthcare providers on the risk factors for poor adherence. Additionally, developing occupation-specific interventions to improve medication adherence may ultimately lead to a reduction in total healthcare spending