Strategies to improve adherence to medications for cardiovascular diseases in socioeconomically disadvantaged populations: A systematic review

Laba, Tracey‐Lea; Bleasel, Jonathan M; Brien, Jo‐anne E; Cass, Alan; Howard, Kirsten; Peiris, David; Redfern, Julie; Salam, Abdul; Usherwood, Tim; Jan, Stephen

doi:10.1016/j.ijcard.2013.01.049

Cited by 39 publications

(43 citation statements)

References 30 publications

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“…3,4 Nonadherence to the treatment is likely to further extend this treatment gap because it is estimated that ≤50% of patients in highincome countries do not adhere to prescribed cardiovascular disease (CVD) medications, with similar suboptimal adherence in low-and middle-income countries. 5,6 The reasons for nonadherence fit into well-recognized categories-health system, condition, patient, therapy, and socioeconomic. 7,8 A review of strategies targeting CVD medication nonadherence in disadvantaged populations found that interventions directed at patients and providers simultaneously showed statistically significant improvements in relative adherence.…”

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confidence: 99%

“…7,8 A review of strategies targeting CVD medication nonadherence in disadvantaged populations found that interventions directed at patients and providers simultaneously showed statistically significant improvements in relative adherence. 6 Cardiovascular polypills which are fixed-dose combinations of frequently indicated cardiovascular medications for highrisk primary prevention and secondary prevention have been trialled internationally to improve provider prescribing and patient medication use. Encouragingly, recent results from randomized controlled trials have shown effectiveness in improving adherence.…”

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confidence: 99%

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Patients’ and Providers’ Perspectives of a Polypill Strategy to Improve Cardiovascular Prevention in Australian Primary Health Care

Liu¹,

Massi²,

Laba³

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Background-This study explores health provider and patient attitudes toward the use of a cardiovascular polypill as a health service strategy to improve cardiovascular prevention. Methods and Results-In-depth, semistructured interviews (n=94) were conducted with health providers and patients from Australian general practice, Aboriginal community-controlled and government-run Indigenous Health Services participating in a pragmatic randomized controlled trial evaluating a polypill-based strategy for high-risk primary and secondary cardiovascular disease prevention. Interview topics included polypill strategy acceptability, factors affecting adherence, and trial implementation. Transcribed interview data were analyzed thematically and interpretively. Polypill patients commented frequently on cost-savings, ease, and convenience of a daily-dosing pill. Most providers considered a polypill strategy to facilitate improved patient medication use. Indigenous Health Services providers and indigenous patients thought the strategy acceptable and beneficial for indigenous patients given the high disease burden. Providers noted the inflexibility of the fixed dose regimen, with dosages sometimes inappropriate for patients with complex management considerations. Future polypill formulations with varied strengths and classes of medications may overcome this barrier. Many providers suggested the polypill strategy, in its current formulations, might be more suited to high-risk primary prevention patients. Conclusions-The polypill strategy was generally acceptable to patients and providers in cardiovascular prevention.Limitations to provider acceptability of this particular polypill were revealed, as was a perception it might be more suitable for high-risk primary prevention patients, though future combinations could facilitate its use in secondary prevention. Participants suggested a polypill-based strategy as particularly appropriate for lowering the high cardiovascular burden in indigenous populations. Clinical Trial Registration-URL: http://www.anzctr.org.au. ANZCTRN: 12608000583347.(Circ Cardiovasc Qual Outcomes. 2015;8:301-308.

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confidence: 99%

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confidence: 99%

Patients’ and Providers’ Perspectives of a Polypill Strategy to Improve Cardiovascular Prevention in Australian Primary Health Care

Liu¹,

Massi²,

Laba³

et al. 2015

Circ: Cardiovascular Quality and Outcomes

Self Cite

View full text Add to dashboard Cite

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“…[9] Successful interventions to improve medication adherence for cardiovascular diseases should ideally target both patients and providers, and address broader social and financial barriers to care, including ability to fill medication prescriptions, and have sufficient access to ongoing follow-up care. [27] One proposed framework for improving patient-provider communication in hypertension care includes understanding provider nonverbal cues and bedside manner, the environmental context in which counseling is conducted (i.e., provider interruptions, distractions) and the patient's background, health literacy and psychosocial factors. [28] The 5 A's intervention used in our study did not explicitly address these broader issues in effective communication.…”

Section: Discussionmentioning

confidence: 99%

Brief provider communication skills training fails to impact patient hypertension outcomes

Manze

Orner

Glickman

et al. 2015

Patient Education and Counseling

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Objectives Hypertension remains a prevalent risk factor for cardiovascular disease, and improved medication adherence leads to better blood pressure (BP) control. We sought to improve medication adherence and hypertension outcomes among patients with uncontrolled BP through communication skills training targeting providers. Methods We conducted a randomized controlled trial to assess the effects of a communication skills intervention for primary care doctors compared to usual care controls, on the outcomes of BP (systolic, diastolic), patient self-reported medication adherence, and provider counseling, assessed at baseline and post-intervention. We enrolled 379 patients with uncontrolled BP; 203 (54%) with follow-up data comprised our final sample. We performed random effects least squares regression analyses to examine whether the provider training improved outcomes, using clinics as the unit of randomization. Results In neither unadjusted nor multivariate analyses were significant differences in change detected from baseline to follow-up in provider counseling, medication adherence or BP, for the intervention versus control groups. Conclusion The intervention did not improve the outcomes; it may have been too brief and lacked sufficient practice level changes to impact counseling, adherence or BP. Practice Implications Future intervention efforts may require more extensive provider training, along with broader systematic changes, to improve patient outcomes.

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“…Lowest adherence to cardiovascular medications is highest among marginalized groups. 13,14 In a Canadian study looking at cultural barriers to participation in cardiac rehabilitation programs, Savage and colleagues 15 identified that although there is universal health care, there is a 5.4-year difference in life expectancy of men of lower socioeconomic status compared with men of highest socioeconomic status, with an 8.4-year difference in women in the same comparison groups. The investigators concluded that participation in cardiac rehabilitation and making healthy lifestyle choices are socially sensitive matters.…”

Section: Underserved Populationsmentioning

confidence: 99%

“…Easy access to local fast food and convenience stores Limited access to fresh fruits or vegetables and the high cost of these items Access to safe walking/exercise environment, parks, or gym facilities Multiple role demands: wage earner, child care provider, elder care provider 4,14 Racial and ethnic diversity of health care providers also plays a key role in providing care in underserved populations. In a cross-sectional analysis of more than 7000 adults by Marrast and colleagues 16 found that nonwhite physicians provided care to a disproportionate share of underserved populations.…”

Section: Underserved Populationsmentioning

confidence: 99%

Cardiovascular Health Among an Underserved Population

Bowers

2015

Nursing Clinics of North America

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Strategies to improve adherence to medications for cardiovascular diseases in socioeconomically disadvantaged populations: A systematic review

Cited by 39 publications

References 30 publications

Patients’ and Providers’ Perspectives of a Polypill Strategy to Improve Cardiovascular Prevention in Australian Primary Health Care

Patients’ and Providers’ Perspectives of a Polypill Strategy to Improve Cardiovascular Prevention in Australian Primary Health Care

Brief provider communication skills training fails to impact patient hypertension outcomes

Cardiovascular Health Among an Underserved Population

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