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Gaps in cardiovascular medication taking: the tip of the iceberg
P Rudd1, J Ramesh, C Bryant-Kosling
1Department of Medicine, Stanford University Medical Center, CA 94305-5475.
Insights
Many patients with cardiovascular conditions have significant gaps in medication adherence, leading to potential health risks. These adherence issues often go undetected by patients and physicians, impacting treatment effectiveness.
Area of Science:
- Cardiology
- Pharmacology
- Patient Adherence Research
Background:
- Medication adherence is crucial for managing chronic cardiovascular conditions.
- Gaps in medication-taking behavior can lead to poor health outcomes, including cardiovascular morbidity and mortality.
- Understanding adherence patterns is essential for improving patient care.
Purpose of the Study:
- To identify significant gaps in medication-taking behavior among patients with cardiovascular conditions.
- To investigate factors contributing to medication non-adherence in this population.
- To determine if these adherence gaps are recognized by patients and healthcare providers.
Main Methods:
- Prospective cohort study of 33 patients with chronic cardiovascular conditions on oral medications.
- Utilized electronic monitoring of pill vial opening, patient self-report, physician estimates, and pill counts to assess medication compliance.
- Followed patients for up to 5 months in general internal medicine and cardiology clinics.
Main Results:
- Despite generally complex medication regimens, 48% of patients exhibited medication-taking gaps exceeding twice the prescribed interval.
- Patient dosing patterns frequently resulted in 'uncovered' intervals, potentially compromising pharmacologic effectiveness.
- These adherence lapses were underestimated by patients and poorly perceived by physicians.
Conclusions:
- Significant medication-taking gaps are common even in carefully selected patient populations and often go undetected.
- These adherence patterns and gaps may contribute to excess cardiovascular morbidity and mortality.
- Further research and improved monitoring strategies are needed to address medication non-adherence in cardiovascular care.
Objective:
To search for major gaps in medication-taking behavior predisposing patients to cardiovascular morbidity and mortality.
Design:
Convenience sample; cohort prospectively followed for < or = 5 months.
Setting:
General internal medicine and cardiology clinics in a university medical center.
Patients:
From among 893 patients, the authors identified 132 eligible individuals and entered 33 subjects (25%) with chronic cardiovascular conditions, 1-3 chronic oral medications for these conditions, overall regimen of < or = 6 drugs, regular visits at 1-3-month intervals, literacy in English, willingness to use electronic monitors, and physician permission to participate.
Outcome Measures:
Medication compliance rates and patterns by patient self-report, physician estimates, pill count, and electronic monitoring of pill vial opening.
Results:
Despite moderately complex regimens (5.4 +/- 0.5 pills daily; range 1-11), most subjects took most medications according to the prescription: median intervals between pill vial openings were 1.00, 0.50, and 0.43 days for once, twice, and three times daily dosing, respectively. Medication-taking gaps of > or = 2 times the prescribed interdosing interval occurred for 48% of the patients. Patients' dosing patterns often produced "uncovered" intervals (mean duration 3.7 days, range 0-25) with doubtful pharmacologic effectiveness. These lapses were underestimated by patients and poorly perceived by their treating physicians, despite familiarity with their care. Baseline sociodemographic, psychosocial, medical system, or clinical characteristics did not predict the patterns or degrees of medication noncompliance.
Conclusions:
Major treatment gaps occur frequently, even in carefully selected ambulatory populations, and generally escape detection. The compliance patterns and gaps may contribute to reported excesses of cardiovascular morbidity and mortality.