Background Following an acute myocardial infarction, patients are prescribed a regime of cardio-protective medication to prevent recurrent cardiovascular events and mortality. Adherence to medication is poor in this patient group, and not fully understood. Current interventions have made limited improvements but are based upon presumed principles. Aim To describe the phenomenon of medicine-taking for an individual taking medication for secondary prevention for an AMI. Method Interpretative Phenomenological Analysis was used to analyse transcripts of semi-structured interviews with participants. Themes were generated for each participant, then summarised across participants. Results Five key themes were produced; the participants needed to compare themselves to others, showed that knowledge of their medicines was important to them, discussed how the future was an unknown entity for them, had assimilated their medicines into their lives, and expressed how an upset to their routine reduced their ability to take medication. Conclusion Participants described complex factors and personal adaptations to taking their medication. This suggests that a patient-centred approach is appropriate for adherence work, and these themes could inform clinical practice to better support patients in their medicine adherence.

Following an acute myocardial infarction, patients are prescribed a regime of cardio-protective medication to prevent recurrent cardiovascular events and mortality. Adherence to medication is poor in this patient group, and not fully understood. Current interventions have made limited improvements but are based upon presumed principles. To describe the phenomenon of medicine-taking for an individual taking medication for secondary prevention for an AMI, Interpretative Phenomenological Analysis was used to analyse transcripts of semi-structured interviews with participants. Themes were generated for each participant, then summarized across participants. Five key themes were produced; the participants needed to compare themselves to others, showed that knowledge of their medicines was important to them, discussed how the future was an unknown entity for them, had assimilated their medicines into their lives, and expressed how an upset to their routine reduced their ability to take medication. Participants described complex factors and personal adaptations to taking their medication. This suggests that a patient-centred approach is appropriate for adherence work, and these themes could inform clinical practice to better support patients in their medicine adherence.

Introduction Following an acute myocardial infarction (AMI), patients are prescribed a daily regime of five medications to prevent secondary cardiovascular events, however medication adherence in this patient group has been measured at only 66%.1 Sub-optimal adherence leads to increased mortality, morbidity and healthcare system costs. Current interventions such as monitored dosage systems, phone message reminders and pharmacist consultations have made some improvements but are largely based on presumptions about adherence than formal evidence. Studying the experience of medication-taking following an AMI, and the personal requirement and adjustment that is required to enable adherence could arguably generate the evidence needed to support future interventions in this field. Aim The aim of this study was to use grounded theory methodology to create a model explaining the process of medication-taking in patients prescribed medication following an AMI. Methods Following ethical approval (UREC 18/36), semi-structured interviews were conducted with thirteen people (based in South-East England) taking medication following at least one AMI episode in the past. The interviews were conducted in person, online or via the telephone and audio-recorded. These recordings were transcribed verbatim and analysed according to constructed grounded theory.2 NVivo software was used to organise and display the coded data and produce a model of the medication-taking process. Results Patients took medication because they wanted to continue living their lives. They saw medication as offering them protection, alongside diet and exercise. Following hospital discharge, patients incorporated medication into their daily routines at home. They used mealtimes and bedtime as a prompt, and kept medication located close to these activities. Patients described rarely missing doses but recognised being away from routines was a cause of medication omission. In this stable stage, patients considered medication-taking unproblematic; they ‘just got on with it’. The professional trust established with the medical team was the basis for following medication directions, and patients conferred the authority to make decisions about their treatment, not wanting to initiate changes themselves; to not ‘rock the boat’. The main cause of change to medication-taking was experiencing adverse bodily effects, ascribed by patients to medication and described as side effects. Patients used small noticeable bodily changes as a prompt for further investigation and information- seeking, after which they presented evidence to the medical team, who instigated medication changes. There was a background dislike of taking medication, which was eased by knowledge of medication action and personal biomedical results. These patients were intentionally adherent to medication but were drawn to question their treatment when ‘side effects’ or misunderstanding arose. Discussion/Conclusion Medication-taking in this group is driven by a desire to live, so they accommodate medication routine to fit their lives, but ‘side effects’ can disturb their intention to continue the routine. This action is reinforced by trust relationships with medical professionals. Resistance to taking medication is alleviated by knowledge of medication action and biomedical results. Practitioners can use patient education, test results and shared decision-making as points to further the patient relationship and strengthen adherence behaviours. References 1. Ma TT, Wong IC, Man KK, Chen Y, Crake T, Ozkor MA, Ding LQ, Wang ZX, Zhang L, Wei L. Effect of evidence-based therapy for secondary prevention of cardiovascular disease: Systematic review and meta-analysis. PLoS One. 2019;14(1):e0210988. 2. Charmaz K. Constructing grounded theory. Sage; 2014.

ObjectiveTo collate existing qualitative research examining patients’ medication-taking experiences in secondary prevention of acute myocardial infarction (AMI) and produce new knowledge, a systematic review and meta-synthesis of patient qualitative studies was conducted.MethodA systematic review found nine reports suitable for inclusion. Themes found by the report authors and report characteristic data were extracted. Reports were assessed for quality. A meta-synthesis using thematic coding and constant comparison method produced higher order themes, and these were used to construct a statement organised by theme using specific examples from the included studies.ResultsAll patients discussed their medication-taking in thematic categories of beliefs about medication and illness, personal ability and interpersonal factors. Themes differed between classes of medication and between patients, suggesting tailored interventions to medications and individual patients would be appropriate. Some themes overlapped with those discussed by the broader group of cardiovascular patients, but some themes were unique to this myocardial infarction patient group, again indicating that a tailored approach is appropriate for this patient group.ConclusionThe themes of beliefs about medication and illness, personal ability and interpersonal support provide tangible starting points for addressing adherence issues. The concept of medication-taking had unique elements within the post-AMI group of patients, and between classes of medication. While these themes were grouped into more generalised higher-order constructs, there were differences between patients within the themed group, indicating that themes are useful as a guide, but individual-level patient support is appropriate.

Introduction Despite significant warnings of adverse effects associated with giving antipsychotics to patients with dementia, these medicines continue to be prescribed for managing the Behavioural and Psychological Symptoms of Dementia (BPSD) in care homes. Information provided by staff working within care homes is a factor that can influence prescribing decisions and how BPSD is managed (1). This provides the rationale for the current study to understand staff attitudes towards antipsychotic prescribing in dementia within care home settings. Aim This quantitative systematic review of survey and questionnaire studies aims to explore the attitudes of staff within care homes towards giving antipsychotics to residents with BPSD. Methods A comprehensive search of the literature published in ten databases was conducted between 26-05-2020 and 19-07-2020 and updated in July 2021. The review protocol was registered and has been published on PROSPERO (CRD42021256879). No time limit was imposed on publication dates. Two reviewers (AR & HP) independently performed the systematic search of the electronic databases and assessed the reporting quality of the papers, again independently, using ‘A Consensus-Based Checklist for Reporting of Survey Studies’ (CROSS) (2). All the identified papers were read in detail, and a structured summary was produced for each according to the following four themes: attitudes toward antipsychotics; barriers to reduced usage; measures implemented within the settings; perceived needs of staff. These summarized data were then formulated as a table to allow comparison of each study and consolidation of the findings. Results 14 papers with 2059 participants, all published in the last decade, were identified for inclusion in the review. Where measured, staff appeared to hold positive beliefs about the effectiveness of antipsychotics in BPSD (n=5). GPs were held responsible for reluctance to complete medication reviews and discontinue antipsychotics in residents (n=1). Antipsychotics were thought to be mainly prescribed for the management of behavioural problems such as agitation, aggression, resistance to care, wandering, hallucination (n=5). Risperidone was stated as a commonly prescribed antipsychotic (n=1). The most frequently reported adverse effects of antipsychotics were increased risk of falls and sedation (n=3). Lower staff education, lack of training, poor antipsychotic medication reviews, lack of resources to implement nonpharmacological methods, and longer working hours/lack of time were viewed as barriers to deprescribing of antipsychotics (n=6). Time was a constraint in managing behavioural problems (n=1). Measures used by the staff to reduce antipsychotic usage included medication reviews, staff education about dementia and its management, dose adjustment of antipsychotics, behavioural assessment tools and nonpharmacological interventions (n=5). Some staff highlighted the need for education, training, resources, and financial and clinical support to reduce the use of antipsychotics (n=4). Conclusion This is the first systematic review which synthesizes quantitative data exploring staff attitudes towards giving antipsychotics to care home residents with BPSD. The positive beliefs about the effectiveness of antipsychotics and the barriers to deprescribing identified provide the impetus for further research. This study was limited by excluding non-English papers. Another limitation was that some domains were rarely explored, e.g. commonly-prescribed medicines, meaning medication preferences could not be summarised. References (1) Janus SI, van Manen JG, IJzerman MJ, Bisseling M, Drossaert CH, Zuidema SU. Determinants of the nurses’ and nursing assistants’ request for antipsychotics for people with dementia. Int Psychogeriatr. 2017 Nov 21;29(3):475-84. (2) Sharma A, Duc NT, Thang TL, Nam NH, Ng SJ, Abbas KS, et al. A Consensus-Based Checklist for Reporting of Survey Studies (CROSS). J Gen Intern Med. 2021 Apr 22;36(10):3179–87.