Adherence to Medications by Patients After Acute Coronary Syndromes

Sud, Anchal; Kline–Rogers, Eva; Eagle, Kim A.; Fang, Jianming; Armstrong, David F.; Rangarajan, Krishna; Otten, Richard F.; Stafkey-Mailey, Dana; Taylor, Stephanie; Erickson, Steven R.

doi:10.1345/aph.1g249

Cited by 86 publications

(79 citation statements)

References 22 publications

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“…8 , 14 , [27][28][29] This analysis adds to the literature by showing that in comparison with other possible barriers to medication adherence, concerns about medications, such as becoming dependent on them or worrying about their long-term consequences, have the strongest association with non-adherence and hence represent a key barrier to overcoming non-adherence, at least in our group of stroke and TIA survivors.…”

Section: Discussionmentioning

confidence: 69%

Key Barriers to Medication Adherence in Survivors of Strokes and Transient Ischemic Attacks

et al. 2013

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BACKGROUND: Even though medications can greatly reduce the risk of recurrent stroke, medication adherence is suboptimal in stroke survivors. OBJECTIVE: To identify key barriers to medication adherence in a predominantly low-income, minority group of stroke and transient ischemic attack (TIA) survivors. DESIGN: Cross-sectional study. PARTICIPANTS: Six hundred stroke or TIA survivors, age ≥ 40 years old, recruited from underserved communities in New York City. MAIN MEASURES: Medication adherence was measured using the 8-item Morisky Medication Adherence Questionnaire. Potential barriers to adherence were assessed using validated instruments. Logistic regression was used to test which barriers were independently associated with adherence. Models were additionally controlled for age, race/ethnicity, income, and comorbidity. KEY RESULTS: Forty percent of participants had poor self-reported medication adherence. In unadjusted analyses, compared to adherent participants, nonadherent participants had increased concerns about medications (26 % versus 7 %, p<0.001), low trust in their personal doctor (42 % versus 29 %, p=0.001), problems communicating with their doctor due to language (19 % versus 12 %, p = 0.02), perceived discrimination from the health system (42 % versus 22 %, p<0.001), difficulty accessing health care (16 % versus 8 %, p=0.002), and inadequate continuity of care (27 % versus 20 %, p=0.05). In the fully adjusted model, only increased concerns about medications [OR 5.02 (95 % CI 2.76, 9.11); p<0.001] and perceived discrimination [OR 1.85 (95 % CI 1.18, 2.90); p= 0.008] remained significant barriers. CONCLUSIONS: Increased concerns about medications (related to worry, disruption, long-term effects, and medication dependence) and perceived discrimination were the most important barriers to medication adherence in this group. Interventions that reduce medication concerns have the greatest potential to improve medication adherence in low-income stroke/ TIA survivors.KEY WORDS: medication adherence; stroke; transient ischemic attack; barriers.

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Section: Discussionmentioning

confidence: 69%

Key Barriers to Medication Adherence in Survivors of Strokes and Transient Ischemic Attacks

et al. 2013

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“…12,13,14,15 In a follow-up of ACS patients at 3 months after hospital discharge, Melloni et al (2009) found that 304 patients (28.2%) reported discontinuation of 1 or more recommended (evidence-based) drug therapies, and most were self-discontinuations (61.5%) that did not include provider involvement. 15 Brookhart et al found that the strongest predictors of restarting statin therapy after a gap of 90 or more days were occurrence of MI (odds ratio [OR] = 12.2, 95% confidence interval [CI] = 8.9-16.9) and an office visit with the physician who initially prescribed the lapsed therapy (OR = 6.1, 95% CI =5.9-6.3).…”

Section: A Multitude Of Patient Factors Contributes To Nonadherencementioning

confidence: 99%

Nonadherence, Clinical Inertia, or Therapeutic Inertia?

Allen¹,

Curtiss²,

Fairman³

2009

JMCP

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in which certain therapies have adequate, even overwhelming if not unequivocal, evidence of effectiveness. 5 Clinical inertia occurs, for example, when the patient fails to attain a biomarker goal (e.g., blood pressure less than 140/90 millimeters of mercury [mm Hg]) due at least in part to failure to intensify pharmacotherapy through upward dosing and/or addition of drugs to the therapeutic regimen. O'Connor et al. attributed clinical inertia 50% to physician factors, 30% to patient factors, and 20% to office-system factors. 4 We might consider the latter category even more broadly to include all health-system factors (Table 1). While we are uncertain about the relative weights for these 3 categories of factors that contribute to clinical inertia, we propose that this conceptual model, including relative weights, should become a focal point in research in nonadherence and failure to attain biomarker and other clinical goals.While acknowledging access, cost, and patient nonadherence, Phillips et al. emphasized the role of clinicians when they wrote in 2001 that clinical inertia occurs when health care providers recognize the problem (failure to attain therapeutic targets in patients with hypertension, dyslipidemia, or diabetes) but fail to act (to initiate or intensify therapy). Clinical inertia is more than failure to act, and it has been shown that other factors such as clinician communication affect adherence. Zolnierek and DiMatteo (2009) discovered in a meta-analysis of 127 studies that the odds of adherence for patients whose physicians had been trained in communication skills were 1.62 times those of patients whose physicians did not receive communication training.

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“…Of the papers relating beliefs about medicines to a measure of medication adherence, some report only necessity beliefs are correlated to medication adherence [19,21,22,[35][36][37][38] while others have found only concern beliefs to be correlated to medication adherence [30,[39][40][41][42][43]. In some studies, the necessity-concerns differential was shown to have a stronger correlation with adherence than necessity or concern beliefs alone [4,20,44,45].…”

Section: Introductionmentioning

confidence: 99%

The necessity–concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis

Foot

Caze

Gujral

et al. 2016

Patient Education and Counseling

130

102

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2 Highlights We investigated the relationship between medication beliefs and adherence  Necessity beliefs were significantly positively correlated with adherence  Concern beliefs were significantly negatively correlated with adherence  Necessity effect size was different in asthma and cardiovascular group 3 Abstract ObjectiveThis meta-analysis investigated whether beliefs in the necessity and concerns of medicine and the necessity-concerns differential are correlated with medication adherence on a population level and in different conditions. MethodsAn electronic search of Web of Science, EMBASE, PubMed and CINAHL was conducted for manuscripts utilising the Beliefs about Medicines Questionnaire and comparing it to any measure of medication adherence. Studies were pooled using the random-effects model to produce a mean overall effect size correlation. Studies were stratified for condition, adherence measure, power and study design. ResultsNinety-four papers were included in the meta-analysis. The overall effect size(r) for necessity, concerns, and necessity-concerns differential was 0.17, -0.18 and 0.24 respectively and these were all significant (p<0.0001). Effect size for necessity was stronger in asthma and weaker in the cardiovascular group compared to the overall effect size. ConclusionNecessity and concerns beliefs and the necessity-concerns differential were correlated with medication adherence on a population level and across the majority of included conditions. The effect sizes were mostly small with a magnitude comparable to other predictors of adherence. Practice implicationsThis meta-analysis suggests that necessity and concern beliefs about medicines are one important factor to consider when understanding reasons for non-adherence.

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Adherence to Medications by Patients After Acute Coronary Syndromes

Abstract: After ACS, not all patients continue their drugs or take them exactly as prescribed. Determining beliefs about illness and medication may be helpful in developing interventions aimed at improving adherence.

Cited by 86 publications

References 22 publications

Key Barriers to Medication Adherence in Survivors of Strokes and Transient Ischemic Attacks

Key Barriers to Medication Adherence in Survivors of Strokes and Transient Ischemic Attacks

Nonadherence, Clinical Inertia, or Therapeutic Inertia?

The necessity–concerns framework predicts adherence to medication in multiple illness conditions: A meta-analysis

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