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Access and adherence to medications for the primary and secondary prevention of atherosclerotic cardiovascular disease in Singapore: a qualitative study

Authors Koh JJK, Cheng RX, Yap YC, Haldane V, Tan YG, Teo KWQ, Srivastava A, Ong PS, Perel P, Legido-Quigley H

Received 4 June 2018

Accepted for publication 7 September 2018

Published 22 November 2018 Volume 2018:12 Pages 2481—2498

DOI https://doi.org/10.2147/PPA.S176256

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen


Joel Jun Kai Koh,1,* Rui Xiang Cheng,2,* Yicheng Yap,2,* Victoria Haldane,1 Yao Guo Tan,2 Krichelle Wei Qi Teo,2 Aastha Srivastava,1 Pei Shi Ong,2 Pablo Perel,3 Helena Legido-Quigley1,3

1Saw Swee Hock School of Public Health, National University of Singapore, Singapore; 2Department of Pharmacy, National University of Singapore, Singapore; 3London School of Hygiene and Tropical Medicine, London, UK

*These authors contributed equally to this work

Background: Atherosclerotic cardiovascular disease (ASCVD) is a growing public health threat globally, and many individuals remain undiagnosed, untreated, and their condition remains uncontrolled. The key to effective ASCVD management is adherence to pharmacotherapy, and non-adherence has been associated with an increased risk of cardiovascular events and complications such as stroke, further impacting a patient’s ability to be adherent. Our qualitative study aimed to explore factors influencing medication adherence in the primary and secondary prevention of ASCVD in Singapore. We propose a synthesized framework, which expands on current understandings of the factors of medication adherence, as a frame of analysis in this study.
Methods: We conducted in-depth, semi-structured interviews with 20 patients over the age of 40 with ASCVD and/or its risk factors in Singapore. QSR Nvivo 11 was used to conduct thematic analysis using an inductive approach.
Results: Using a synthesized framework, we reported that complex medication regimens, the lack of support received during regimen changes, and the perceived seriousness of a condition could impact a patient’s medication adherence. Key findings suggest that the relationship between health care professionals and patients impacted patient acceptability of the medication regimen and consequently medication adherence. Different patient beliefs regarding diagnosis, medication, and adherence had some bearing on the ability to perceive the need to adhere to their medication. Patients also reported that they could afford medication, sometimes with the help of family members. Patients also largely reported not needing help managing their medication, considering it an individual responsibility.
Conclusion: We identified key factors which future interventions looking to improve medication adherence ought to consider. These include changing patient perceptions of health systems, diagnosis, medication, and adherence; patient-centeredness in developing interventions that facilitate adherence through building self-efficacy and stronger support networks via patient empowerment and engagement; decreasing patient co-payments on medication; and cultivating a trusting patient–provider relationship.

Keywords: atherosclerotic cardiovascular disease, medication adherence, access, qualitative research, Singapore

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