Impact of community pharmacist intervention discussing patients’ beliefs to improve medication adherence
- 819 Downloads
Background Adherence to evidence based medicines in patients who have experienced a myocardial infarction remains low. Individual’s beliefs towards their medicines are a strong predictor of adherence and may influence other factors that impact on adherence. Objective To investigate if community pharmacists discussing patients’ beliefs about their medicines improved medication adherence at 12 months post myocardial infarction. Setting This study included 200 patients discharged from a public teaching hospital in Queensland, Australia, following a myocardial infarction. Patients were randomised into intervention (n = 100) and control groups (n = 100) and followed for 12 months. Method All patients were interviewed between 5 to 6 weeks, at 6 and 12 months post discharge by the researcher using the repertory grid technique. This technique was used to elicit the patient’s individualised beliefs about their medicines for their myocardial infarction. In the intervention group, patients’ beliefs about their medicines were communicated by the researcher to their community pharmacist. The pharmacist used this information to tailor their discussion with the patient about their medication beliefs at designated time points (3 and 6 months post discharge). The control group was provided with usual care. Main outcome measure The difference in non-adherence measured using a medication possession ratio between the intervention and control groups at 12 months post myocardial infarction. Results There were 137 patients remaining in the study (intervention group n = 72, control group n = 65) at 12 months. In the intervention group 29 % (n = 20) of patients were non-adherent compared to 25 % (n = 16) of patients in control group. Conclusion Discussing patients’ beliefs about their medicines for their myocardial infarction did not improve medication adherence. Further research on patients beliefs should focus on targeting non-adherent patients whose reasons for their non-adherence is driven by their medication beliefs.
KeywordsAdherence Australia Beliefs Community pharmacist intervention Myocardial infarction Repertory grid technique
We would like to thank all study participants and community pharmacists involved in this research for giving up their time to take part in the study.
This work was supported by the Pharmacy Board of Queensland Research Grants Program 2008, Brisbane, Queensland. The Pharmacy Board had no input in the research design, methodology or results. The ideas expressed in this manuscript are those of the authors and are not intended to represent the position of the Board or members of the Board.
Conflicts of interest
There are no conflicts of interest.
- 1.National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand. Guidelines for the management of acute coronary syndromes. Med J Aust. 2006;184(8):1–32.Google Scholar
- 2.National Collaborating Centre For Primary Care. Secondary prevention in primary and secondary care for patients following a myocardial infarction. United Kingdom: National Institute for Health and Clinical Excellence; 2007.Google Scholar
- 3.Kushner FG, Hand M, Smith SC Jr, King SB III, Anderson JL, Antman EM, et al. 2009 Focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Circulation. 2009;120(22):2271–306.PubMedCrossRefGoogle Scholar
- 4.Chew DP, Aroney CN, Aylward PE, Kelly AM, White HD, Tideman PA, et al. 2011 Addendum to the National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand guidelines for the management of acute coronary syndromes (ACS) 2006. Heart Lung Circ. 2011;20(8):487–502.PubMedCrossRefGoogle Scholar
- 10.World Health Organization. Adherence to long-term therapies: evidence for action. Geneva, 2003.Google Scholar
- 15.Schwitzgebel E. “Belief”, The Stanford Encyclopedia of Philosophy 2014 [cited 2014 May 12]. Spring 2014 ed. http://plato.stanford.edu/entries/belief/.
- 22.Kelly GA. The psychology of personal constructs. 1st ed. New York: Norton; 1955.Google Scholar
- 26.Mårdby AC, Åkerlind I, Jörgensen T. Beliefs about medicines and self-reported adherence among pharmacy clients. Patient Educ Couns. 2007;69(1):158-164.Google Scholar
- 27.van den Bemt BJF, van den Hoogen FHJ, Benraad B, Hekster YA, van Riel PLCM, van Lankveld W. Adherence rates and associations with nonadherence in patients with rheumatoid arthritis using disease modifying antirheumatic drugs. J Rheumatol. 2009;36(10):2164–2170.Google Scholar
- 29.Hess G, Preblick R, Hill J, Plauschinat CA, Yaskin J. Effects of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy after hospital discharge on subsequent rehospitalization for acute myocardial infarction and heart failure. Congest Heart Fail. 2009;15(4):170–5.PubMedCrossRefGoogle Scholar
- 36.Cutrona SL, Choudhry NK, Fischer MA, Servi AD, Stedman M, Liberman JN, et al. Targeting cardiovascular medication adherence interventions. J Am Pharm Assoc. 2011;52(3):381–97.Google Scholar