Despite advances in preventative drug therapy, cardiovascular disease remains the leading cause of death in the United States.
Despite advances in preventative drug therapy, cardiovascular disease (CVD) remains the leading cause of death in the United States.
Medication nonadherence contributes significantly to the persistence of CVD. As the number of patients with atherosclerosis rises globally, nonadherence will remain a significant cause of adverse health outcomes and a primary driver of increasing health care costs.
Previous literature has identified various reasons for medication nonadherence, including prohibitive medication costs, fear of adverse effects, and misunderstanding of the medication’s benefits. The lack of immediate, conspicuous benefits of a medication for chronic disease, such as a statin for reducing blood cholesterol, is also often cited. Finally, the formation of a “sick identity” among patients taking a medication may lead to medication nonadherence.
Several studies have described various strategies to improve medication adherence. However, patient-physician communication about cardioprotective medication adherence hasn’t been explored.
Recently, a group of researchers sought to identify patients’ and physicians’ beliefs and practices regarding discussions of cardioprotective medication adherence. To achieve this aim, they conducted a survey-based study of 2 academic and 2 community-based cardiology practices in the Chicago metropolitan area from June 2, 2015, to July 22, 2015.
Physicians were contacted via telephone and told that the general goal of the study was “to understand an important aspect of patient-physician communication,” though they weren’t told the specific aims. The same interviewer for the study attended a morning or afternoon session of each participating physician’s practice and invited consecutive patients to complete a short, orally administered survey following the patient’s visit.
The study included patients 18 years or older who were taking a cardioprotective medication and excluded patients who didn’t speak English.
The results of the survey were quite striking. Forty patients (61%) reported rarely or never discussing their medication adherence with their physician. Of those 40 patients, 18 (45%) said that they sometimes or usually forgot to take their medication, and 4 (10%) reported having missed 1 or more doses of medication in the past 2 weeks.
On the basis of a standardized adherence score, 8 of the 66 patients (12%) had poor adherence and 36 (55%) had moderate adherence. Of the 8 patients with the poorest adherence, only 1 (13%) was correctly identified by the patient’s physician as being poorly adherent.
The results of the physician survey were no better. Fourteen of the 21 physicians (67%) disagreed or strongly disagreed with the statement, “I am aware of how often my patient misses a dose of medication,” despite the fact that all 21 physicians (100%) agreed with the statement, “It is important for me to discuss medication adherence with my patient.”
Eight of the 21 physicians (38%) reported there were times when they wanted to discuss adherence with a patient but didn’t do so. Of those 8 physicians, 5 (63%) cited time as the greatest barrier to such discussions and 3 (38%) reported believing that their patient had more important problems to be addressed.
To me, these findings illustrate a huge opportunity for pharmacists to fill a very large void in the present care of cardiovascular patients. We need to get involved with educating patients about the importance of adhering to their cardiovascular medications. This is especially important for those with established CVD, as these medications are highly effective at reducing mortality and preventing recurrent cardiovascular events.
Patients should be taught that even though they may not feel any symptoms from their hypertension or high cholesterol, they must continue to take their cardioprotective medications. Pharmacists should also screen for high-cost medications and suggest cheaper generic equivalents whenever possible.
These simple interventions can go a long way, and may even help keep patients alive and out of the hospital.
Hines R, Stone NJ. Patients and physicians beliefs and practices regarding adherence to cardiovascular medication. JAMA Cardiol. Published online May 11, 2016. doi:10.1001/jamacardio.2016.0634.