Patient Perspectives on Factors Influencing Medication Adherence Among People with Coronary Heart Disease (CHD) and CHD Risk Factors
Authors Mondesir FL, Levitan EB, Malla G, Mukerji R, Carson AP, Safford MM, Turan JM
Received 6 July 2019
Accepted for publication 25 October 2019
Published 29 November 2019 Volume 2019:13 Pages 2017—2027
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Melinda Thomas
Peer reviewer comments 2
Editor who approved publication: Dr Johnny Chen
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, USA
Correspondence: Favel L Mondesir
Division of Cardiovascular Medicine, School of Medicine, University of Utah, Room 4A100, 30 N 1900 E, Salt Lake City, UT 84132, USA
Background: 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
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