Adherence to coronary artery disease secondary prevention medicines: exploring modifiable barriers

Abstract

BackgroundNon-adherence to secondary prevention medicines (SPMs) among patients with coronary artery disease (CAD) remains a challenge in clinical practice. This study attempted to identify actual and potential modifiable barriers to adherence that can be addressed in cardiology clinical practice.MethodsThis was a cross-sectional, postal survey-based study of the medicines-taking experience of patients with CAD treated at a secondary/tertiary care centre. All participants had been on SPM for ≥3 months.ResultsIn total, 696 eligible patients were sent the survey and 503 responded (72.3%). The median age was 70 years, and 403 (80.1%) were male; the median number of individual daily doses of all medicines was 6. The rate of non-adherence to at least one SPM was 43.5% (n=219), but 53.3% of reported non-adherence was to only one SPM. Statins contributed to 66.7% and aspirin to 61.7% of overall non-adherence identified by the Single Question (SQ) tool. In 30.8% of non-adherent patients (n=65), this was at least partly intentional. Barriers included forgetfulness (84.9%; n=186), worry that medicines will do more harm than good (33.8%; n=74), feeling hassled about medicines taking (18.7%; n=41), feeling worse when taking medicines (14.2%; n=31) and not being convinced of the benefit of medicines (9.1%; n=20). In a multivariate analysis, modifiable factors associated with overall non-adherence included being prescribed aspirin (OR: 2.22; 95% CI: 1.18 to 4.17), having specific concern about SPM (OR: 1.12; 95% CI: 1.07 to 1.18) and issues with repeat prescriptions (OR: 2.48; 95% CI: 1.26 to 4.90). Different factors were often associated with intentional versus unintentional non-adherence.ConclusionsUsing appropriate self-report tools, patients share actual and potential modifiable barriers to adherence that can be addressed in clinical practice. Non-adherence behaviour was selective. Most non-adherence was driven by forgetfulness, concern about the harm caused by SPM and practical barriers.

The my experience of taking medicines (MYMEDS) questionnaire for assessing medicines adherence barriers in post-myocardial infarction patients: development and utility

“…relating to forgetfulness or inconvenience). These issues have been associated with non-adherence in our research and that of others [4,20,22,25], and can potentially be addressed in clinical practice.…”

“…Potentially modifiable factors often associated with non-adherence to SPM were initially identified based on a literature review. This was followed by an analysis of our own patients, and these data have been published elsewhere [18][19][20]. Among many barriers to adherence with SPM identified, the most common were forgetfulness, worry that medicines could do more harm than good, feeling inconvenienced about medicines taking, and not being convinced of the benefit of medicines.…”

“…It is based on a modified version of the SQ tool [9]. In our experience, this tool alone is not sufficiently sensitive to distinguish all non-adherence behaviour but, within the context of the whole MYMEDS questionnaire, it can be helpful in identifying specific problematic medicines [20]. A five-point Likert scale is used in this section of MYMEDS, and patients are considered to be non-adherent if they select any answer other than 'all of the time' for adherence to any SPM.…”

“…The impact of these factors has proved to be inconsistent. By focusing on a wide range of modifiable factors, with a known impact on adherence [4,20,22,25], the MYMEDS questionnaire can be used to start a personalised conversation that puts the patient in control and provides an adaptable action plan for overcoming specific barriers.…”

“…We therefore designed a self-reporting tool for identifying modifiable barriers to adherence among patients prescribed CV SPM in normal clinical practice. This instrument, known as the My Experience of Taking Medicines (MYMEDS) questionnaire, was derived from a wide-range literature review, expert input, and an extensive analysis of adherence behaviour among over 500 patients with coronary artery disease [18][19][20]. The tool was used in clinical practice as part of an innovative post MI medicines and risk optimisation programme which was highly praised by our patients [21].…”