Medication adherence and predictive factors in patients with cardiovascular disease: A comparison study between Australia and Iraq

Abstract

Background: Adherence to cardiac medication regimes is essential for effective treatment of cardiovascular disease but is unsatisfactory in Australia and little studied in Iraq. Aim: This study evaluated and compared adherence to cardiac medications and potentially predictive factors based on the Theory of Planned Behaviour (TPB) in patients with cardiovascular disease admitted to hospital and attending cardiac services in Australia and Iraq. Methods: A cross-sectional multi-centre comparative study involving 246 cardiac patients was conducted in Australia (one hospital in Sydney) and Iraq (three cardiac hospitals in Baghdad) between October 2016 and December 2017. Adherence to medications and related factors were examined using established, validated questionnaires, formally translated and validated into Arabic for Iraqi participants. Binary logistic regression was conducted to determine those factors independently predictive of cardiac medication adherence, in Australia and Iraq. Findings: A significantly higher proportion (64.3%) of Iraqi than Australian (37.5%) cardiac patients reported medium/low levels of adherence to their cardiac medications. After adjusting for confounding factors, the ability to correctly self-administer and refill medications, and beliefs about cardio-protective medication were identified as independent predictors of cardiac medication adherence behaviour in both Australian and Iraqi participants. In Iraq, patients recruited from outpatient cardiac clinics were significantly more likely to report adherent behaviours than patients recruited as in-patients of the cardiac ward. Conclusion: Non-adherence to cardiac medications differed but was sub-optimal in both Australian and Iraqi patient samples, in both countries, adherence was associated with patients' beliefs about medications, and ability to self-administer and refill medications. Clinical nurses and pharmacists need to investigate these factors at every point in the cardiac trajectory to optimise medication adherence.

Non‐prescription medicines may contribute to non‐adherence to prescription medicines in people living with chronic health conditions

“…In contrast, Australian studies by Laba et al and Al‐Ganmi et al found no significant correlation between non‐adherence and demographic factors . Both Laba et al and Al‐Ganmi et al also found no correlation with non‐adherence and therapy‐related factors . These are consistent with findings from the review by Gast and Mathes which found mostly no impact on adherence by therapy intake regimen .…”

“…Similar to this, reviews of non‐adherence literature have found an association with age, education and employment . In contrast, Australian studies by Laba et al and Al‐Ganmi et al found no significant correlation between non‐adherence and demographic factors . Both Laba et al and Al‐Ganmi et al also found no correlation with non‐adherence and therapy‐related factors .…”

“…Studies relating to medication adherence in an Australian population are currently limited. To date, four studies have investigated factors investigating medication adherence in an Australian population; however, these involved only a small sample size of less than 250 participants . As such, non‐adherence needs to be further explored in the Australian context including assessing the impact of factors such as the number of CHCs and polypharmacy.…”

Psychosocial Determinants of the Intention to Take Oral Antihypertensive Drugs: A Cross-sectional Study

“…the same context. These findings reinforce the importance of strategies aimed at valuing aspects related to the subjective and individual beliefs of each user with systemic arterial hypertension (7).…”

“…The behavioral intention that involves the act of taking the prescribed pill can be influenced by factors that may be beyond the control of the individual, such as the ability to access the medications, their psychosocial and health characteristics (7), beliefs regarding the treatment, health knowledge, recognition of the need for medication (8)(9), understanding of the practicalities and difficulties in managing the disease and stable marital status (1). Other factors such as ignorance of the benefits and adverse effects of the medication and ineffective communication with the team that prescribes care are described as causes of low adherence to drug therapy (1,(7)(8)(9).…”