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Background <p>Medication nonadherence and physician-switching undermine treatment outcomes and strain healthcare systems. This study examined the prevalence and determinants of medication noncompliance and doctor-switching behavior among outpatient populations in Karachi, Pakistan, where socioeconomic and systemic barriers significantly influence care-seeking patterns.</p> Methods <p>A cross-sectional study was conducted from May to August 2024 in a public hospital in Karachi using non-probability convenience sampling. A total of 287 adult outpatients completed a validated, self-administered questionnaire which assessing demographics, medication-taking behavior, non-adherence, healthcare utilization, and physician-switching tendencies. Data were analyzed using descriptive statistics, chi-square tests, and binary logistic regression in SPSS 23.0, with <i>p</i> &lt; 0.05 considered significant.</p> Results <p>Medication nonadherence was common, with 50.5% reporting frequent missed doses; only 17.4% reported full adherence. Primary nonadherence was low, as 81.5% initiated prescribed treatments. Logistic regression identified poor communication quality as the strongest independent predictor of nonadherence (OR = 4.82; 95% CI 3.21–7.24; <i>p</i> &lt; 0.001), while higher education level (OR = 1.34; 95% CI 1.08–1.67; <i>p</i> = 0.008) and lower medication count (OR = 0.78; 95% CI 0.66–0.92; <i>p</i> = 0.004) were also significant predictors. Physician-switching occurred in 41.1% of respondents, mainly due to dissatisfaction with treatment (31.7%). Key adherence barriers included fear of long-term side effects (51.9%), conflicting medical advice (63.1%), and inadequate physician communication (28.2%). Although most participants (85.4%) felt comfortable discussing concerns, communication gaps remained substantial.</p> Conclusion <p>Nonadherence and physician-switching are widespread in Karachi, driven by communication deficits, dissatisfaction, and systemic shortcomings. Healthcare providers should prioritize structured communication skills training and patient-centered counseling. Policymakers should address structural barriers—including consultation time, medication cost, and access to consistent care—to reduce both nonadherence and unnecessary physician-switching. Strengthening patient-provider interactions and improving health system responsiveness are essential to enhance adherence and continuity of care.</p>

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Determinants of medication nonadherence and physician-switching behavior among outpatient populations in Karachi, Pakistan: a cross-sectional analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月28日

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  • Mubashir Zafar,
  • Tooba Adil,
  • Tafazzul Hyder Zaidi,
  • Hafiza Tooba Siddiqui,
  • Talha Farooq,
  • Areej Sohail,
  • Ayesha Javed,
  • Rashaqha Rahman,
  • Abeer Riaz,
  • Aysha Asif,
  • Areeshah Tariq,
  • Laiba Tanzeem,
  • Muhammad Hunain Aslam,
  • Faareah Mansoor,
  • Ramisha Fahim,
  • Muhammad Noman Siddiqui

摘要

Background

Medication nonadherence and physician-switching undermine treatment outcomes and strain healthcare systems. This study examined the prevalence and determinants of medication noncompliance and doctor-switching behavior among outpatient populations in Karachi, Pakistan, where socioeconomic and systemic barriers significantly influence care-seeking patterns.

Methods

A cross-sectional study was conducted from May to August 2024 in a public hospital in Karachi using non-probability convenience sampling. A total of 287 adult outpatients completed a validated, self-administered questionnaire which assessing demographics, medication-taking behavior, non-adherence, healthcare utilization, and physician-switching tendencies. Data were analyzed using descriptive statistics, chi-square tests, and binary logistic regression in SPSS 23.0, with p < 0.05 considered significant.

Results

Medication nonadherence was common, with 50.5% reporting frequent missed doses; only 17.4% reported full adherence. Primary nonadherence was low, as 81.5% initiated prescribed treatments. Logistic regression identified poor communication quality as the strongest independent predictor of nonadherence (OR = 4.82; 95% CI 3.21–7.24; p < 0.001), while higher education level (OR = 1.34; 95% CI 1.08–1.67; p = 0.008) and lower medication count (OR = 0.78; 95% CI 0.66–0.92; p = 0.004) were also significant predictors. Physician-switching occurred in 41.1% of respondents, mainly due to dissatisfaction with treatment (31.7%). Key adherence barriers included fear of long-term side effects (51.9%), conflicting medical advice (63.1%), and inadequate physician communication (28.2%). Although most participants (85.4%) felt comfortable discussing concerns, communication gaps remained substantial.

Conclusion

Nonadherence and physician-switching are widespread in Karachi, driven by communication deficits, dissatisfaction, and systemic shortcomings. Healthcare providers should prioritize structured communication skills training and patient-centered counseling. Policymakers should address structural barriers—including consultation time, medication cost, and access to consistent care—to reduce both nonadherence and unnecessary physician-switching. Strengthening patient-provider interactions and improving health system responsiveness are essential to enhance adherence and continuity of care.