Background: Medication non adherence leads to increased morbidity and mortality and undermines the ability of clinicians to provide effective care. While the relationship between medication adherence and demographic, socioeconomic and clinical factors has been well studied, it is unclear whether a strong physician-patient relationship and satisfaction with care may improve medication adherence. Furthermore, medication adherence has not been specifically evaluated in the rural South. Design and Participants: This is a cross sectional study using data from the Southern Rural Access Program evaluation, which surveyed adults in 9 rural states via random digit dialing from November 2002 until July 2003. Respondents that had seen a health care provider in the past year were included in the analysis. Measurements: Respondents were asked whether they had delayed or not gotten a prescription filled in the last year. Elsewhere on the questionnaire, they were also asked about their satisfaction with, confidence in, and their length of relationship with their regular provider. Bivariate and multivariable analyses were used to identifY factors associated with individuals filling their prescriptions. Results: The mean age of our sample was 46 years, 68% were white, 19% had less than a high school education, and 22.7% were uninsured. Of the 3,926 respondents that had visited a provider in the past year, 793 (20%) reported that they delayed or did not fill a prescription. After multivariable modeling, individuals less than 65 years old (OR 2.9, CI[95%] 2.00, 4.24), male (OR 1.3, CI[95%] 1.05, 1.66), income less than $25,000 (OR 1.8, CI[95%] 1.16, 2.69), more educated (OR 1.4, CI[95%] 1.06, 1.92), uninsured (OR 1.4, CI[95%] 1.09, 1.89), insured under Medicare (OR 1.81, CI[95%] 1.25, 2.63), and in fair or poor health (OR 1.4, CI[95%] 1.13, 1.81) were less likely to have filled a prescription, after controlling for all other variables. Respondents that had a regular source of care (OR 0.4, CI[95%] 0.22, 0.88), a longer relationship with their doctor (OR 0.8, CI[95%] 0.64, 1.01), and were satisfied with the concern shown by their doctor (OR 0.60, CI[95%] 0.38, 0.94) were more likely to have filled their prescriptions. Those that were concerned about the cost of health care (OR 2.6, CI[95%] 2.05, 3.18) or had problems with transportation (OR 1.7, CI[95%] 1.25, 2.31) were less likely to have filled their prescriptions. Individuals who believed in going to the doctor early in the course of illness and for regular check ups (OR 0.7, CI[95%] 0.49, 0.93) were more likely to have filled their prescriptions. Conclusions: Primary medication non adherence is common in the rural South. Satisfaction with concern shown by the physician, having a regular source of care, and having a longer relationship with a physician are associated with better medication adherence.Master of Public Healt
