Patient Preference and Adherence (Nov 2019)
Patient Perspectives on Factors Influencing Medication Adherence Among People with Coronary Heart Disease (CHD) and CHD Risk Factors
Abstract
Favel L Mondesir,1 Emily B Levitan,2 Gargya Malla,2 Reshmi Mukerji,3 April P Carson,2 Monika M Safford,4 Janet M Turan5 1Division of Cardiovascular Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA; 2Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA; 3School of Medicine, Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA; 4Department of Medicine, Weill Cornell Medicine, New York, NY, USA; 5Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USACorrespondence: Favel L MondesirDivision of Cardiovascular Medicine, School of Medicine, University of Utah, Room 4A100, 30 N 1900 E, Salt Lake City, UT 84132, USATel +1-801-587-9048Email [email protected]: Few qualitative studies have explored factors influencing medication adherence among people with coronary heart disease (CHD) or CHD risk factors. We explored how factors related to the patient (e.g. self-efficacy), social/economic conditions (e.g. social support and cost of medications), therapy (e.g. side effects), health condition (e.g. comorbidities), and the healthcare system/healthcare team (e.g. support from healthcare providers and pharmacy access) influence medication adherence, based on the World Health Organization Multidimensional Adherence Model (WHO-MAM).Methods: We conducted 18 in-depth qualitative interviews from April to July 2018 with ambulatory care patients aged ≥45 years (8 black men, 5 black women, 2 white men, and 3 white women) who were using medications for diabetes, hypertension, dyslipidemia and/or CHD. We used thematic analysis to analyze the data, and sub-themes emerged within each WHO-MAM dimension.Findings: Patient-related factors included beliefs about medications as important for self and faith; the desire to follow the advice of family, friends, and influential others; and self-efficacy. Social/economic factors included observations of social network members and information received from them; social support for medication adherence and pharmacy utilization; and economic influences. Therapy-related barriers included side effects and medicine schedules. Only a few participants mentioned condition-related factors. Healthcare system/healthcare team-related factors included support from doctors and pharmacists; and ease of pharmacy access and utilization.Conclusion: These results underscore the need for multidimensional interventions aimed at improving medication adherence and overall health of patients with CHD and CHD risk factors.Keywords: medication adherence, qualitative research, coronary heart disease, diabetes, hypertension, dyslipidemia
