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Factors Associated With Nonadherence to Cardiovascular Medications: A Cross-sectional Study
Danielle M van der Laan1, Petra J M Elders, Christel C L M Boons
1Danielle M. van der Laan, MSc Doctoral Student, Department of Clinical Pharmacology and Pharmacy and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands. Petra J.M. Elders, PhD, MD Postdoctoral Fellow, Department of General Practice & Elderly Care Medicine and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands. Christel C.L.M. Boons, MSc Doctoral Student, Department of Clinical Pharmacology and Pharmacy and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands. Giel Nijpels, PhD, MD Professor, Department of General Practice & Elderly Care Medicine and Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands. Jacqueline G. Hugtenburg, PhD, Pharm Postdoctoral Fellow, Department of Clinical Pharmacology and Pharmacy and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands.
Insights
Medication nonadherence in cardiovascular patients often stems from forgetting doses and ambivalent attitudes toward medications. Interventions should address unintentional nonadherence and patient beliefs for better adherence.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Cardiovascular medications are vital for disease prevention, yet suboptimal adherence is common.
- Understanding the multifaceted nature of medication nonadherence is crucial for developing effective interventions.
- This study investigates factors contributing to nonadherence in patients using cardiovascular drugs.
Purpose of the Study:
- To identify factors associated with nonadherence to cardiovascular medications.
- To explore the relationship between patient characteristics and medication-taking behavior.
- To inform the development of targeted adherence enhancement strategies.
Main Methods:
- Cross-sectional study including 255 patients from Dutch community pharmacies.
- Data collected on demographics, medication/disease characteristics, knowledge, quality of life, and attitudes toward medicines.
- Nonadherence assessed via pharmacy refill data (proportion of days covered <80%).
Main Results:
- Factors associated with nonadherence included forgetting medication doses.
- Insufficient knowledge on managing forgotten doses was a significant factor.
- An ambivalent attitude toward medicines (high necessity and high concerns) correlated with nonadherence.
Conclusions:
- Interventions should focus on the unintentional aspects of nonadherence, such as forgetting.
- Providing tools and information to prevent forgetting is recommended.
- Addressing intentional nonadherence by exploring patients' beliefs about medicines is essential.
Background:
Cardiovascular medications have well-established benefits in the primary and secondary prevention of cardiovascular diseases. Unfortunately, adherence to these medicines is often suboptimal. To develop interventions intended to enhance adherence to cardiovascular medications, more insight is needed into the complex character of medication nonadherence.
Objective:
The aim of the present study was to identify which factors are associated with nonadherence to cardiovascular medications in a sample of patients from Dutch community pharmacies.
Methods:
In this cross-sectional study, patients using cardiovascular medications from 23 community pharmacies were included. Patient demographics, medication and disease characteristics, knowledge, quality of life, attitude toward medicines, and satisfaction with information were assessed. Both an adherent sample (n = 146) and a sample of patients nonadherent to prescribed medications (n = 109) during the last 6 months as assessed with pharmacy refill data (proportion of days covered <80%) were selected. Associations with refill nonadherence were assessed using univariate and multivariate logistic regression analyses.
Results:
In total, 255 patients participated (53.3% men, 71.6 ± 10.9 years). Factors associated with cardiovascular medication nonadherence in multivariate analyses included experiencing difficulties with medication use due to forgetting, having insufficient knowledge on what to do when a dose is forgotten, and having an ambivalent attitude toward medicines (beliefs of high necessity and high concerns).
Conclusions:
Intervention strategies to enhance cardiovascular medication nonadherence should be targeted mainly to the unintentional dimension of nonadherence and include information and tools to prevent forgetting. Conversely, the influence of factors that underlie intentional nonadherence, particularly patients' beliefs about medicines, should also be addressed.
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