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International Journal of Clinical Pharmacy

, Volume 36, Issue 5, pp 1048–1058 | Cite as

Impact of community pharmacist intervention discussing patients’ beliefs to improve medication adherence

  • Gina GujralEmail author
  • Karl Winckel
  • Lisa M. Nissen
  • W. Neil Cottrell
Research Article

Abstract

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.

Keywords

Adherence Australia Beliefs Community pharmacist intervention Myocardial infarction Repertory grid technique 

Notes

Acknowledgments

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.

Funding

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.

References

  1. 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. 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. 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. 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
  5. 5.
    Ho PM, Magid DJ, Masoudi FA, McClure DL, Rumsfeld JS. Adherence to cardioprotective medications and mortality among patients with diabetes and ischemic heart disease. BMC Cardiovasc Disord. 2006;6:48.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Choudhry NK, Glynn RJ, Avorn J, Lee JL, Brennan TA, Reisman L, et al. Untangling the relationship between medication adherence and post-myocardial infarction outcomes: medication adherence and clinical outcomes. Am Heart J. 2014;167(1):51–8.e5.PubMedCrossRefGoogle Scholar
  7. 7.
    Ho PM, Spertus JA, Masoudi FA, Reid KJ, Peterson ED, Magid DJ, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med. 2006;166(17):1842–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Akincigil A, Bowblis JR, Levin C, Jan S, Patel M, Crystal S. Long-term adherence to evidence based secondary prevention therapies after acute myocardial infarction. J Gen Intern Med. 2008;23(2):115–21.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Sud A, Kline-Rogers EM, Eagle KA, Fang J, Armstrong DF, Rangarajan K, et al. Adherence to medications by patients after acute coronary syndromes. Ann Pharmacother. 2005;39(11):1792–7.PubMedCrossRefGoogle Scholar
  10. 10.
    World Health Organization. Adherence to long-term therapies: evidence for action. Geneva, 2003.Google Scholar
  11. 11.
    AlGhurair SA, Hughes CA, Simpson SH, Guirguis LM. A systematic review of patient self-reported barriers of adherence to antihypertensive medications using the world health organization multidimensional adherence model. J Clin Hypertens. 2012;14(12):877–86.CrossRefGoogle Scholar
  12. 12.
    Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2008;2:CD000011.PubMedGoogle Scholar
  13. 13.
    Janz NK, Becker MH. The health belief model: a decade later. Health Educ Q. 1984;11(1):1–47.PubMedCrossRefGoogle Scholar
  14. 14.
    Horne R, Weinman J, Hankins M. The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999;14(1):1–24.CrossRefGoogle Scholar
  15. 15.
    Schwitzgebel E. “Belief”, The Stanford Encyclopedia of Philosophy 2014 [cited 2014 May 12]. Spring 2014 ed. http://plato.stanford.edu/entries/belief/.
  16. 16.
    Horne R, Weinman J. Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health. 2002;17(1):17–32.CrossRefGoogle Scholar
  17. 17.
    Byrne M, Walsh J, Murphy AW. Secondary prevention of coronary heart disease: patient beliefs and health-related behaviour. J Psychosom Res. 2005;58(5):403–15.PubMedCrossRefGoogle Scholar
  18. 18.
    Horne R, Chapman SC, Parham R, Freemantle N, Forbes A, Cooper V. Understanding patients’ adherence-related beliefs about medicines prescribed for long-term conditions: a meta-analytic review of the necessity-concerns framework. PLoS ONE. 2013;8(12):e80633.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    George J, Mackinnon A, Kong DC, Stewart K. Development and validation of the beliefs and behaviour questionnaire (BBQ). Patient Educ Couns. 2006;64(1–3):50–60.PubMedCrossRefGoogle Scholar
  20. 20.
    McHorney CA. The adherence estimator: a brief, proximal screener for patient propensity to adhere to prescription medications for chronic disease. Curr Med Res Opin. 2009;25(1):215–38.PubMedCrossRefGoogle Scholar
  21. 21.
    Hahn SR, Park J, Skinner EP, Yu-Isenberg KS, Weaver MB, Crawford B, et al. Development of the ASK-20 adherence barrier survey. Curr Med Res Opin. 2008;24(7):2127–38.PubMedCrossRefGoogle Scholar
  22. 22.
    Kelly GA. The psychology of personal constructs. 1st ed. New York: Norton; 1955.Google Scholar
  23. 23.
    Beller EM, Gebski V, Keech AC. Randomisation in clinical trials. Med J Aust. 2002;177(10):565–7.PubMedGoogle Scholar
  24. 24.
    Cottrell WN, Denaro CP, Emmerton L. Exploring beliefs about heart failure treatment in adherent and nonadherent patients: use of the repertory grid technique. Patient Prefer Adherence. 2013;7:141–50.PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Percival M, Cottrell WN, Jayasinghe R. Exploring the beliefs of heart failure patients towards their heart failure medicines and self care activities. Int J Clin Pharm. 2012;34(4):618–25.PubMedCrossRefGoogle Scholar
  26. 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. 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
  28. 28.
    Geers HC, de Blaey CJ, Egberts AC, Bouvy ML, Heerdink ER. Early identification of long-term poor adherence in ambulatory patients. Ann Pharmacother. 2006;40(12):2277–8.PubMedCrossRefGoogle Scholar
  29. 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
  30. 30.
    Perreault S, Dragomir A, Blais L, Berard A, Lalonde L, White M, et al. Impact of better adherence to statin agents in the primary prevention of coronary artery disease. Eur J Clin Pharmacol. 2009;65(10):1013–24.PubMedCrossRefGoogle Scholar
  31. 31.
    Hansen RA, Kim MM, Song L, Tu W, Wu J, Murray MD. Comparison of methods to assess medication adherence and classify nonadherence. Ann Pharmacother. 2009;43(3):413–22.PubMedCrossRefGoogle Scholar
  32. 32.
    Rasmussen JN, Chong A, Alter DA. Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA. 2007;297(2):177–86.PubMedCrossRefGoogle Scholar
  33. 33.
    Gislason GH, Rasmussen JN, Abildstrom SZ, Gadsboll N, Buch P, Friberg J, et al. Long-term compliance with beta-blockers, angiotensin-converting enzyme inhibitors, and statins after acute myocardial infarction. Eur Heart J. 2006;27(10):1153–8.PubMedCrossRefGoogle Scholar
  34. 34.
    Simpson E, Beck C, Richard H, Eisenberg MJ, Pilote L. Drug prescriptions after acute myocardial infarction: dosage, compliance, and persistence. Am Heart J. 2003;145(3):438–44.PubMedCrossRefGoogle Scholar
  35. 35.
    Shah ND, Dunlay SM, Ting HH, Montori VM, Thomas RJ, Wagie AE, et al. Long-term medication adherence after myocardial infarction: experience of a community. Am J Med. 2009;122(10):961.e7–13.CrossRefGoogle Scholar
  36. 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
  37. 37.
    Calvert SB, Kramer JM, Anstrom KJ, Kaltenbach LA, Stafford JA, Allen LNM. Patient-focused intervention to improve long-term adherence to evidence-based medications: a randomized trial. Am Heart J. 2012;163(4):657–65.e1.PubMedCrossRefGoogle Scholar
  38. 38.
    Piette JD, Weinberger M, McPhee SJ, Mah CA, Kraemer FB, Crapo LM. Do automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes? Am J Med. 2000;108(1):20–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Rowe G, Lambert N, Bowling A, Ebrahim S, Wakeling I, Thomson R. Assessing patients’ preferences for treatments for angina using a modified repertory grid method. Soc Sci Med. 2005;60(11):2585–95.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Gina Gujral
    • 1
    Email author
  • Karl Winckel
    • 1
    • 2
  • Lisa M. Nissen
    • 1
    • 3
  • W. Neil Cottrell
    • 1
  1. 1.School of PharmacyThe University of QueenslandBrisbaneAustralia
  2. 2.Department of PharmacyPrincess Alexandra HospitalBrisbaneAustralia
  3. 3.School of Clinical SciencesQueensland University of TechnologyBrisbaneAustralia

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