Understanding non-adherence in chronic heart failure: a mixed-method case study

Oertle, Marc; Bal, Roland

doi:10.1136/qshc.2009.033563

Cited by 15 publications

(20 citation statements)

References 29 publications

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“…Most recently, Hirt et al and Oertle et al included a qualitative aspect in their GAI studies and showed that GAI is significantly higher when quantitative as well as qualitative patient data are considered. This supports previous data showing that patient and prescriber factors may be important barriers to guideline adherence .…”

Section: Discussionsupporting

confidence: 89%

A tool for assessment of heart failure prescribing quality: A systematic review and meta‐analysis

Hadidi

Darweesh

Byrne

et al. 2018

Pharmacoepidemiology and Drug

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Section: Discussionsupporting

confidence: 89%

A tool for assessment of heart failure prescribing quality: A systematic review and meta‐analysis

Hadidi

Darweesh

Byrne

et al. 2018

Pharmacoepidemiology and Drug

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“…Patients who present for surgery with significant depressive symptoms and lack of motivation may benefit from established and highly effective methods to improve motivation for following preoperative instructions, rather than efforts to simply make these instructions easier to understand. Similar suggestions have emerged from a recent qualitative study that looked at perspectives on non-adherence between heart failure patients and their treating physicians in which patients perceived themselves as “understanding what to do but needing help with how to carry out [instructions]” whereas doctors perceived patients as “not understanding… and therefore needing more repetition of knowledge-based instructions.” 61 The present study offers some support to the generalizability of such findings to the preoperative physician-patient encounter.…”

Section: Discussionsupporting

confidence: 69%

Preoperative Depression Symptom Severity and Its Impact on Adherence to Preoperative Beta-Blocker Therapy

Schonberger

Feinleib²,

Holt³

et al. 2014

Journal of Cardiothoracic and Vascular Anesthesia

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Objective 1) To test the association among depression symptoms, distressed personality-type, and preoperative beta-blocker non-adherence. 2) To estimate the prevalence of untreated major depression in this population. Design Prospective Observational Study Setting A Veterans hospital Patients 120 subjects on outpatient beta-blocker therapy presenting for surgery. Interventions The Patient Health Questionnaire (PHQ)-9, the D-Scale-14 (DS14), and Modified Morisky Scale (MMS) questionnaires. Measurements and Main Results Of 99 participants who presented for surgery, the incidence of preoperative non-adherence was 14.1% (95% CI 7–21%), consistent with prior research. Non-adherence was 9.5% among those with no depression, 27.8% among those with mild depression, and 28.6% among those with moderate to severe depression (Cochrane-Armitage test for trend p=0.03). Distressed personality-type was found in 35% of the cohort (95% CI 26–45%) and was not associated with beta-blocker non-adherence (Fisher’s exact p=0.24). Among participants with symptoms of Major Depressive Disorder (N=25, 25.3%), over half (N=14, 56%) had no indication of depression listed at their most recent primary care visit. Conclusions Patients with symptoms of depression on chronic beta-blocker therapy are prone to medication non-adherence on the day of surgery. The majority of surgical patients with symptoms of major depression lack a diagnosis of depression. Preoperative depression screening may thus 1) identify a population at increased risk of beta-blocker withdrawal and 2) identify patients who may benefit from anesthesiologist-initiated referral for this treatable condition.

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“…12 Prevalent themes in a mixed-methods study aimed at understanding nonadherence in HF included clinical constraints related to low blood pressure or heart rate and renal dysfunction; uncertainty about treatments and symptom improvement; omissions and errors with drugs and drug dosing; patient factors related to comorbidities, polypharmacy, and adherence when multiple changes (increase and decrease) in drug doses were made by 386 Circ Heart Fail March 2015 healthcare providers; and lack of collaboration from inpatient to outpatient care, especially related to medications. 13 Similar themes related to physical, psychological, economic, social, and behavioral (self-care) quality of life (QoL) were brought forward when patients with symptomatic HF were interviewed to understand perceived QoL.…”

Section: Patient Characteristics and Unmet Needsmentioning

confidence: 99%

Transitions of Care in Heart Failure

Albert¹,

Barnason²,

Deswal³

et al. 2015

Circ: Heart Failure

219

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In patients with heart failure (HF), use of 30-day rehospitalization as a healthcare metric and increased pressure to provide value-based care compel healthcare providers to improve efficiency and to use an integrated care approach. Transition programs are being used to achieve goals. Transition of care in the context of HF management refers to individual interventions and programs with multiple activities that are designed to improve shifts or transitions from one setting to the next, most often from hospital to home. As transitional care programs become the new normal for patients with chronic HF, it is important to understand the current state of the science of transitional care, as discussed in the available research literature. Of transitional care reports, there was much heterogeneity in research designs, methods, study aims, and program targets, or they were not well described. Often, programs used bundled interventions, making it difficult to discuss the efficiency and effectiveness of specific interventions. Thus, further HF transition care research is needed to ensure best practices related to economically and clinically effective and feasible transition interventions that can be broadly applicable. This statement provides an overview of the complexity of HF management and includes patient, hospital, and healthcare provider barriers to understanding end points that best reflect clinical benefits and to achieving optimal clinical outcomes. The statement describes transitional care interventions and outcomes and discusses implications and recommendations for research and clinical practice to enhance patient-centered outcomes.

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Understanding non-adherence in chronic heart failure: a mixed-method case study

Cited by 15 publications

References 29 publications

A tool for assessment of heart failure prescribing quality: A systematic review and meta‐analysis

A tool for assessment of heart failure prescribing quality: A systematic review and meta‐analysis

Preoperative Depression Symptom Severity and Its Impact on Adherence to Preoperative Beta-Blocker Therapy

Transitions of Care in Heart Failure

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