Barriers and facilitators to medication adherence in patients after PCI surgery: A mixed-methods systematic review

Abstract

Aims To systematically synthesize the quantitative and qualitative evidence on barriers and facilitators to medication adherence in patients after percutaneous coronary intervention (PCI) surgery. Background Medication adherence in patients after PCI surgery is paramount in the secondary prevention of coronary heart disease. While numerous studies have explored factors influencing medication adherence in patients and devised intervention strategies to improve it, these interventions often remain limited to medication reminders and health education, with less-than-optimistic outcomes. A comprehensive understanding of barriers and facilitators to medication adherence in patients after PCI surgery and the development of integrated intervention strategies may prove to be more effective. Design: A convergent integrated mixed-methods systematic review was conducted using the JBI approach. Methods Literature on barriers and facilitators of medication adherence in patients after PCI surgery was systematically searched in English and Chinese databases including PubMed, Embase, CINAHL, Web of Science, CNKI, Wanfang, and CBM, from inception to March 1, 2023. Screening of literature was conducted based on inclusion and exclusion criteria. Two researchers independently performed data extraction and quality assessment. The analysis of barriers and facilitators of medication adherence in patients was based on the six sub-components of the Capability, Opportunity, Motivation, and Behavior (COM-B) model. The systematic review was registered on PROSPERO (CRD42022338400). Results A total of 15 studies were included in the analysis, encompassing 3 qualitative studies, 5 cross-sectional studies, and 7 cohort studies. The research identified 30 influencing factors that were categorized into six sub-components (physical capability, psychological capability, reflective motivation, automatic motivation, physical opportunity, and social opportunity). Conclusion Identifying of barriers and facilitators of medication adherence within the six categories of the COM-B model in patients undergoing PCI can serve as a foundation for developing intervention strategies. It is recommended to implement comprehensive approaches that target factors in different domains to improve medication adherence among PCI patients.