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Recent regulatory changes towards an exclusion of immunosuppressive regimes from aut idem regulations in Germany underline the necessity of medication adherence among transplant patients [32, 33].
Among the dimensions of illness perception, this is the greatest predictor of adherence to treatment (Phillips, Leventhal, & Burns, 2016) and, as per the Necessity and Concerns Framework, patients who believe in the necessity of medication are more likely to be compliant (Foot, La Caze, Gujral, & Cottrell, 2016; Ross, Walker, & MacLeod, 2004).
There is a tension experienced by RA patients when assessing the necessity of medication against concern regarding adverse effects [ 36].
This finding supports Horne and Weinman's framework on the relationship between necessity of medication and concerns related to medication.
We conclude that, in patients with IBD, perceived necessity of medication is weighed against general and specific concerns as well as outcome expectancies.
Patients with stronger beliefs about the necessity of medication and who believed medications were generally not overused were more likely to be adherent to medication [ 34].
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In another RA study, Treharne et al. [ 34] found that strong beliefs about the necessity of medications and believing medications not to be harmful predicted higher self-reported adherence but data were only available for White patients.
In our study, patients who found their medication list most comprehensive had less concerns towards their medication and regular receipt of an updated medication list was associated with higher perceived necessity of the medication.
The main emerging themes centred on their acceptance and perceived necessity of their medication, the fears and concerns held towards their medication, the perceived impact, actual or potential, that their illness and symptoms had on their lives and willingness to self-manage.
Regular receipt of an updated medication list was associated with higher perceived necessity of the medication, while the memory of a "brown bag review" was negatively associated with perceived necessity.
Some patients explained how they actively sought information about their disease and the effects of the medication to be better able to assess the necessity of the medication and to allay their concerns, but their accounts suggested that the information available to them often fell short of meeting their needs.
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