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

Abstract 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.