Ambulatory assessment of medication adherence in high cardiovascular-risk patients. The Polish population of the EUROASPIRE V survey
, 2, 1, 3, 4, 5, 6, 7, 8, 1
Abstract
Introduction: Patients’ non-compliance with therapeutic recommendations is an important factor limiting the effectiveness of the treatment. This study aimed to compare patients’ declarations regarding their drug intake (Medication Adherence Questionnaire) with the results of the Adherence in Chronic Disease Scale (ACDS). Material and methods: The study included 200 patients (66.5% women) without prior cardiovascular events, diagnosed with hypertension, hypercholesterolemia, or diabetes within 6-24 months before the inclusion. To assess the therapeutic plan implementation the ACDS and the MAQ questionnaires were used. Results: Based on patients’ declarations, a satisfactory level of adherence (MAQ 5 and MAQ 4) was reported for 75.58% of patients treated for hypertension, 51.62% for diabetes, and 62.22% for hypercholesterolemia. A non-adherence risk assessment with the use of the ACDS yielded high results (i.e. low risk of non-adherence) in 38.58% of hypertension patients, 51.61% of diabetes patients 41.11% of hypercholesterolemia patients. Regardless of the disease, the patients indicating full (MAQ 5) or almost full (MAQ 4) therapeutic plan implementation often did not confirm that in similar question 1 of the ACDS. Conclusions: Patients’ self-assessment of the implementation of a therapeutic plan poses a risk of overestimation; particularly when it is based on answering only a single question. Additional application of the ACDS seems to help assess the risk of non-adherence as well as define barriers, beliefs, and behaviors that determine it. This assessment provides the basis to take action to improve the therapeutic plan implementation.
Keywords: cardiovascular-risk patientsadherenceself-reported questionnaires
References
- Kubica A, Grześk G, Sinkiewicz W, et al. Compliance, concordance, adherence w przewlekłej terapii. Folia Cardiol Excerpta. 2010; 5: 54.
- Simpson SH, Eurich DT, Majumdar SR, et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006; 333(7557): 15.
- Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005; 353: 1972–1974.
- Kardas P. Możliwości oceny przestrzegania zaleceń terapeutycznych w praktyce lekarskiej. In: Gaciąg Z, Kardas P. ed. Nieprzestrzeganie zaleceń terapeutycznych. Od przyczyn do praktycznych rozwiązań. Naukowa Fundacja Polfarmy, Warszawa 2015.
- Buszko K, Obońska K, Michalski P, et al. The Adherence Scale in Chronic Diseases (ASCD). The power of knowledge: the key to successful patient — health care provider cooperation. Medical Research Journal. 2016; 1(1): 37–42.
- World Health Organization. Adherence to long-term therapies: evidence for action. http://whqlibdoc.who.int › publications.
- Kubica A, Kosobucka A, Michalski P, et al. The Adherence in Chronic Diseases Scale — a new tool to monitor implementation of a treatment plan. Folia Cardiol. 2017; 12: 19–26.
- Kubica A, Kosobucka A, Fabiszak T, et al. Assessment of adherence to medication in patients after myocardial infarction treated with percutaneous coronary intervention. Is there a place for newself-reported questionnaires? Curr Med Res Opin. 2019; 35(2): 341–349.
- Kosobucka A, Michalski P, Pietrzykowski Ł, et al. Adherence to treatment assessed with the Adherence in Chronic Diseases Scale in patients after myocardial infarction. Patient Prefer Adherence. 2018; 12: 333–340.
- Kubica A, Kasprzak M, Obońska K, et al. Discrepancies in assessment of adherence to antiplatelet treatment after myocardial infarction. Pharmacology. 2015; 95(1-2): 50–58.
- Pietrzykowski Ł, Kasprzak M, Michalski P, et al. The influence of patient expectations on adherence to treatment regimen after myocardial infarction. Patient Educ Couns. 2021 [Epub ahead of print].
- Pietrzykowski Ł, Kasprzak M, Michalski P, et al. Therapy Discontinuation after Myocardial Infarction. J Clin Med. 2020; 9(12).
- Kubica A, Kasprzak M, Siller-Matula J, et al. Time-related changes in determinants of antiplatelet effect of clopidogrel in patients after myocardial infarction. Eur J Pharmacol. 2014; 742: 47–54.
- Kardas P, Lewek P, Matyjaszczyk M. Determinants of patient adherence: a review of systematic reviews. Front Pharmacol. 2013; 4: 91.
- Sabaté E. (red.): Adherence to long-term therapies: evidence for action. World Health Organization. Geneva 2003.
- Forbes CA, Deshpande S, Sorio-Vilela F, et al. A systematic literature review comparing methods for the measurement of patient persistence and adherence. Curr Med Res Opin. 2018; 34(9): 1613–1625.
- Anghel LA, Farcas AM, Oprean RN. An overview of the common methods used to measure treatment adherence. Med Pharm Rep. 2019; 92(2): 117–122.
- Nguyen TM, La Caze A, Cottrell N. What are validated self-report adherence scales really measuring?: a systematic review. Br J Clin Pharmacol. 2014; 77(3): 427–445.
- Kubica A, Kosobucka A, Fabiszak T, et al. Assessment of adherence to medication in patients after myocardial infarction treated with percutaneous coronary intervention. Is there a place for newself-reported questionnaires? Curr Med Res Opin. 2019; 35(2): 341–349.
- Pietrzykowski Ł, Kasprzak M, Michalski P, et al. Medication adherence and its determinants in patients after myocardial infarction. Sci Rep. 2020; 10(1): 12028.
- Fischer MA, Stedman MR, Lii J, et al. Primary medication non-adherence: analysis of 195,930 electronic prescriptions. J Gen Intern Med. 2010; 25(4): 284–290.
- Kubica A. Współpraca z pacjentem — podstawowy warunek skuteczności terapii w chorobie wieńcowej. Choroby Serca i Naczyń. 2009; 6: 131–134.
- Kubica A, Pietrzykowski Ł. The therapeutic plan implementation in patients discharged from the hospital after myocardial infarction. Medical Research Journal. 2021; 6(2): 79–82.
- Kubica A, Gruchała M, Jaguszewski M, et al. Adherence to treatment — a pivotal issue in long-term treatment of patients with cardiovascular diseases. An expert standpoint. Medical Research Journal. 2018; 2(4): 123–127.
- Kubica A. Edukacja zdrowotna na tle wybranych czynników a skuteczność terapii antyagregacyjnej u pacjentów po zawale serca. Wydawnictwo Naukowe Uniwersytetu Mikołaja Kopernika, Toruń 2012.