Skip to main content
SpringerLink
Log in

Improving Treatment Regimen Adherence in Coronary Heart Disease by Targeting Patient Types

  • Leading Article
  • Published:
Disease Management & Health Outcomes

Abstract

Patient adherence to a treatment plan is central to the control of coronary heart disease (CHD) and in the prevention of complications; it is reported to be the single most important challenge in the management of CHD and related conditions. The following article provides an overview of adherence in CHD, with particular emphasis on two important theories of behavior change: the ‘Health Belief Model’ and the ‘Transtheoretical Model’. Three types of individuals are discussed in relation to these theories: (i) patients who are non-adherent (5–10% of the CHD population); (ii) patients who are partially adherent (30–40% of the CHD population); and (iii) patients who are near-optimally adherent (50–60% of the CHD population). Adherence predictor strategies and recommended interventions for each of these groups are provided in table format. Disease management tools and resources that assist in targeting interventions to the unique adherence needs of these three very different groups are also listed. It was our conclusion that regardless of the interventions that are utilized in CHD management programs, understanding the differences between partially adherent, non-adherent, and near-optimally adherent patients, and targeting interventions to these groups, can optimize the impact of CHD interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Fig. 1
Fig. 2
Table II

Similar content being viewed by others

Notes

  1. Data from patients enrolled in a managed care plan participating in the Health Plan Employer Data and Information Set.

  2. Although much of the literature uses the term ‘compliance’ when discussing patient compliance or adherence to a treatment plan, the use of the term ‘adherence’ is generally preferred since this recognizes a greater degree of patient involvement and responsibility.

  3. In calculating adherence, PDC is most commonly used in the literature. This refers to the proportion between the quantity of drug dispensed and number of days supplied from each filled prescription. The adherence goal of 80% of prescribed dose is typically used in clinical trials to assess the efficacy and safety of new drugs. Figures used in this section are estimated from short-term electronic monitoring.[8]

References

  1. NCQA. The state of managed care quality, 2002. Washington, DC: NCQA, 2002

    Google Scholar 

  2. National Cholesterol Education Program. ATP III final report. Circulation 2002; 106: 3359

    Google Scholar 

  3. American Heart Association. Compliance action program. Dallas (TX): AHA, 2002

    Google Scholar 

  4. Ellis WM. Compliance action program: an opportunity to fight the nation’s leading cause of death. J Am Pharm Assoc (Wash) 2001; 41(4): 623–5

    CAS  Google Scholar 

  5. Taylor H, Leitman R. Harris Interactive Health Care News. Out-of-pocket costs are a substantial barrier to prescription durg compliance [online]. Available from URL: http://www.harrisinteractive.com/news/allnewsbydate.asp?New-sID=393 [Accessed 2004 Aug 13]

  6. Urquhart J. Partial compliance in cardiovascular disease: risk implications. Br J Clin Pract Suppl 1994; 73: 2–12

    PubMed  CAS  Google Scholar 

  7. Benner JS, Gwynn RJ, Mogun H, et al. Long-term persistence in use of statin therapy in elderly patients. JAMA 2002; 288(4): 455–61

    Article  PubMed  Google Scholar 

  8. Cramer JA. Effect of partial compliance on cardiovascular medication effectiveness. Heart 2002; 88: 203–6

    Article  PubMed  Google Scholar 

  9. Rudd P. Compliance with antihypertensive therapy: a shifting paradigm. Cardiol Rev 1994; 2(5): 230–40

    Article  Google Scholar 

  10. Vermeire E, Hearnshaw H, Van Royen P, et al. Patient adherence to treatment: three decades of research: a comprehensive review. J Clin Pharm Ther 2001; 26: 331–42

    Article  PubMed  CAS  Google Scholar 

  11. Turpin RS, Jungkind K, Salvucci L. The HEDIS Performance NAVIGATOR for controlling high blood pressure: a resource to assist health plans improve patient adherence. Dis Manag Health Outcome 2003; 6(1): 43–51

    Google Scholar 

  12. Rimer BK, Glanz K, Lerman C. Contributions of public health to patient compliance. J Community Health 1991; 16(4): 225–40

    Article  PubMed  CAS  Google Scholar 

  13. Svensson S, Kjellgren KI, Ahlner J, et al. Reasons for adherence with antihypertensive medication. Int J Cardiol 2000; 76: 157–63

    Article  PubMed  CAS  Google Scholar 

  14. Rybacki JJ. Improving cardiovascular health in postmenopausal women by addressing medication adherence issues. J Am Pharm Assoc (Wash) 2002; 42: 63–73

    Article  Google Scholar 

  15. Ghandi SK, Xiaodong K. Quality-of-life measures in the evaluation of antihypertensive drug therapy: reliability, validity and quality-of-life domains. Clin Ther 1996; 18(6): 1276–95

    Article  Google Scholar 

  16. Rand CS. Measuring adherence with therapy for chronic diseases: implications for the treatment of heterozygous familial hypercholesterolemia. Am J Cardiol 1993; 72: 68D–74D

    Article  PubMed  CAS  Google Scholar 

  17. Ockene IS, Hayman LL, Pasternak RC, et al. Adherence issues and behavior changes: achieving a long-term solution. J Am Coll Cardiol 2002; 40(4): 579–651

    Article  Google Scholar 

  18. Donovan JL, Blake DR. Patient non-compliance: deviance or reasoned decisionmaking? Soc Sci Med 1992; 34(5): 507–13

    Article  PubMed  CAS  Google Scholar 

  19. Carruthers SG. Assimilating new therapeutic interventions into clinical practice: how does hypertension compare with other therapeutic areas?. Am Heart J 1999; 138(3 Pt 2): S256–60

    Article  Google Scholar 

  20. Strecher VJ, Rosenstock IM. The Health Belief Model. In: Glanz K, Lewis FM, Rimer BK, editors. Health behavior and health education: theory, research and practice. San Francisco (CA): Jossey-Bass, 1997: 41–59

    Google Scholar 

  21. Prochaska JO. The transtheoretical model and stages of change. In: Glanz K, Lewis FM, Rimer BK, editors. Health behavior and health education: theory, research and practice. San Francisco (CA): Jossey-Bass, 1997: 60–83

    Google Scholar 

  22. LaRosa JH, LaRosa JC. Enhancing drug compliance in lipid-lowering treatment. Arch Fam Med 2000; 9: 1169–75

    Article  PubMed  CAS  Google Scholar 

  23. Avorn J, Monette J, Lacour A, et al. Persistence of use of lipid-lowering medications. JAMA 1998; 279(18): 1458–62

    Article  PubMed  CAS  Google Scholar 

  24. Guilbert R, Leduc N, Fournier P, et al. What factors determine whether individuals found to have hypercholesterolemia at mass screening accept advice to visit their physician. Public Health 1999; 113: 105–10

    Google Scholar 

  25. Sung JC, Nichol MB, Venturini F, et al. Factors affecting patient compliance with antihyperlipidemic medications in an HMO population. Am J Manag Care 1998; 4: 1421–30

    PubMed  CAS  Google Scholar 

  26. Jackevicius CA, Mandani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002; 288(4): 462–7

    Article  PubMed  Google Scholar 

  27. Kiortsis DN, Giral P, Bruckert E, et al. Factors associated with low compliance with lipid-lowering drugs in hyperlipidemic patients. J Clin Pharm Ther 2000; 25: 445–51

    Article  PubMed  CAS  Google Scholar 

  28. Pettinger MB, Waclawiw MA, Davis KB, et al. Compliance to multiple interventions in a high risk population. Ann Epidemiol 1999; 9(7): 408–18

    Article  PubMed  CAS  Google Scholar 

  29. Wannemacher J, Schepers GP, Townsend KA. Antihypertensive medication compliance in a Veterans Affairs healthcare system. Ann Pharmacother 2002; 36: 986–91

    Article  PubMed  Google Scholar 

  30. Shaw E, Anderson JG, Maloney M, et al. Factors associated with noncompliance of patients taking antihypertensive medications. Hosp Pharm 1995; 30(3): 206–7

    Google Scholar 

  31. Brown CM, Segal R. The effects of health and treatment perceptions on the use of prescribed medication and home remedies among African American and white American hypertensives. Soc Sci Med 1996; 43(6): 903–17

    Article  PubMed  CAS  Google Scholar 

  32. Glazer KM, Emery CF, Frid DJ, et al. Psychological predictors of adherence and outcomes among patients in cardiac rehabilitation. J Cardpulm Rehabil 2002; 22(1): 40–6

    Article  Google Scholar 

  33. Dusing R. Changes in antihypertensive therapy: the role of adverse effects and compliance. Blood Press 1998; 7: 313–5

    Article  PubMed  CAS  Google Scholar 

  34. Feldman R, Bacher M, Campbell N, et al. Adherence to pharmacologie management of hypertension. Can J Public Health 1998; 89(5): I16–8

    PubMed  CAS  Google Scholar 

  35. Small RE, Freeman-Arnold SB, Goode JV, et al. Evaluation of the total costs of treating elderly hypertensive patients with ACE inhibitors: a comparison of older and newer agents. Pharmacotherapy 1997; 17(5): 1011–6

    PubMed  CAS  Google Scholar 

  36. Caro JJ, Speckman JL. Existing treatment strategies: does noncompliance make a difference?. J Hypertens 1998; 16 Suppl. 7: S31–4

    CAS  Google Scholar 

  37. Insull W. The problem of compliance to cholesterol altering therapy. J Intern Med 1997; 241: 317–25

    Article  PubMed  CAS  Google Scholar 

  38. Caro JJ. Stepped care for hypertension: are the assumptions valid?. J Hypertens 1997; 15 Suppl. 7: S35–9

    CAS  Google Scholar 

  39. Rizzo JA, Simons WR. Variations in compliance among hypertensive patients by drug class: implications for health care costs. Clin Ther 1997; 19(6): 1446–57

    Article  PubMed  CAS  Google Scholar 

  40. Mancia G, Failla M, Grappiola A, et al. Present and future role of combination treatment in hypertension. J Cardiovasc Pharmacol 1998; 31 Suppl. 2: S41–4

    Article  PubMed  CAS  Google Scholar 

  41. Iskedjian M, Einarson TR, MacKeigan LD, et al. Relationship between daily dose frequency and adherence to antihypertensive pharmacotherapy: evidence from a meta-analysis. Clin Ther 2002; 24(2): 302–16

    Article  PubMed  Google Scholar 

  42. Bailey JE, Lee MD, Somes GW, et al. Risk factors for antihypertensive medication refill failure by patients under Medicaid managed care. Clin Ther 1996; 18(6): 1252–62

    Article  PubMed  CAS  Google Scholar 

  43. Ren XS, Kazis LE, Lee A, et al. Identifying patient and physician characteristics that affect compliance with antihypertensive medications. J Clin Pharm Ther 2002; 27: 47–56

    Article  PubMed  CAS  Google Scholar 

  44. Rudd P. Compliance with antihypertensive therapy: raising the bar of expectations. Am J Manag Care 1998; 4(7): 957–66

    PubMed  CAS  Google Scholar 

  45. Newell SA, Bowman JA, Cockburn JD. A critical review of interventions to increase compliance with medication-taking, obtaining medication refills, and appointment-keeping in the treatment of cardiovascular disease. Prev Med 1999; 29: 535–48

    Article  PubMed  CAS  Google Scholar 

  46. Burke LE, Dunbar-Jacob JM, Hill MN. Compliance with cardiovascular disease prevention strategies: a review of the research. Ann Behav Med 1997; 19(3): 239–63

    Article  PubMed  CAS  Google Scholar 

  47. McInnes GT. Integrated approaches to management of hypertension: promoting treatment acceptance. Am Heart J 1999; 138(3): S252–5

    Article  Google Scholar 

  48. Patton K, Meyers J, Lewis BE. Enhancement of compliance among patients with hypertension. Am J Manag Care 1997; 3 (11): 1693–8

    PubMed  CAS  Google Scholar 

  49. Wilkening BJ. Patients’ and physicians’ assessment of risks associated with hypertension and benefits from treatment. J Cardiovasc Risk 1998; 5(3): 161–6

    Article  Google Scholar 

  50. Cramer JA. Consequences of intermittent treatment for hypertension: the case for medication compliance and persistence. Am J Manag Care 1998; 4(22): 1563–8

    PubMed  CAS  Google Scholar 

  51. Mitka M. Cardiologists like statins: more than patients do. JAMA 2001; 286(22): 2799–800

    Article  PubMed  CAS  Google Scholar 

  52. Applegate WB. Elderly patients’ adherence to statin therapy. JAMA 2002; 288(4): 495–7

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors gratefully acknowledge Beth Bridges, Steve Teutsch, Camelot Ives, Douglas Jordan, and Thomas McCready for their assistance with this project, and Marc Berger and Peter Nebenfuhr for their continued support of this initiative. No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review. The authors are employees and stockholders of Merck & Co., Inc.

Author information

Authors and Affiliations

  1. Outcomes Research & Management, Merck & Co., Inc., WP39-166, West Point, 19486-0004, USA

    Robin S. Turpin (Director), Jeffrey B. Simmons, Janice F. Lew, Charles M. Alexander, Marie A. Dupee, Patricia Kavanagh & Ellen R. Cameron

Authors
  1. Robin S. Turpin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jeffrey B. Simmons
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janice F. Lew
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Charles M. Alexander
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marie A. Dupee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Patricia Kavanagh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ellen R. Cameron
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robin S. Turpin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turpin, R.S., Simmons, J.B., Lew, J.F. et al. Improving Treatment Regimen Adherence in Coronary Heart Disease by Targeting Patient Types. Dis-Manage-Health-Outcomes 12, 377–383 (2004). https://doi.org/10.2165/00115677-200412060-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-200412060-00004

Keywords

Search

Navigation