open access

Vol 2, No 4 (2017)
REVIEW ARTICLES
Published online: 2018-03-30
Get Citation

Adherence to treatment — a pivotal issue in long-term treatment of patients with cardiovascular diseases. An expert standpoint

Aldona Kubica, Marcin Gruchała, Miłosz Jaguszewski, Piotr Jankowski, Damian Świeczkowski, Piotr Merks, Izabella Uchmanowicz
DOI: 10.5603/MRJ.2017.0016
·
Medical Research Journal 2017;2(4):123-127.

open access

Vol 2, No 4 (2017)
REVIEW ARTICLES
Published online: 2018-03-30

Abstract

The adherence to treatment is defined as the extent to which a person’s behaviour, including taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health-care provider. Non-adherence to medication may lead to increased morbidity, mortality, and costs to the healthcare system. Therefore, it is pivotal to know the patient’s true adherence to medication, understand the causes of low adherence, and take actions to improve adherence. The authors assumed that individual, complex health education started during hospitalisation and continued after discharge, explaining the pathophysiology and symptoms of the disease, elucidating goals and potential benefits of treatment, and highlighting the risk of premature termination of therapy, with use of additional methods helping patients to remember treatment schedule will enhance adherence to treatment. There is an urgent need to develop and test a dedicated procedure covering all these activities. Introduction. A substantial proportion of patients with cardiovascular diseases do not respond to the treatment sufficiently [1–3]. Several factors of poor response to medication should be taken into ac-count, including inadequate drug intake [4–6]. To systematise the phenomenon of following medical recommendations, the term “adherence” was proposed. The World Health Organisation (WHO) defines “adherence” as “the extent to which a person’s behaviour, including taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare pro-vider” [7]. Adherence has been also defined as the “active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behaviour to produce a therapeutic result” [8]. Previously the term ‘compliance’ was widely used, particularly in negative concord as ‘non-compliance’. Nowadays ‘compliance’ is associated with a more pejorative connotation than ‘adherence’ because ‘non-compliance issues’ are mostly patient-oriented without a deeper view into the different set of factors, e.g. obstacles identified in the healthcare system. Thus, currently in scientific deliberations we usually prefer usage of the term ‘adherence’ [9].

Abstract

The adherence to treatment is defined as the extent to which a person’s behaviour, including taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health-care provider. Non-adherence to medication may lead to increased morbidity, mortality, and costs to the healthcare system. Therefore, it is pivotal to know the patient’s true adherence to medication, understand the causes of low adherence, and take actions to improve adherence. The authors assumed that individual, complex health education started during hospitalisation and continued after discharge, explaining the pathophysiology and symptoms of the disease, elucidating goals and potential benefits of treatment, and highlighting the risk of premature termination of therapy, with use of additional methods helping patients to remember treatment schedule will enhance adherence to treatment. There is an urgent need to develop and test a dedicated procedure covering all these activities. Introduction. A substantial proportion of patients with cardiovascular diseases do not respond to the treatment sufficiently [1–3]. Several factors of poor response to medication should be taken into ac-count, including inadequate drug intake [4–6]. To systematise the phenomenon of following medical recommendations, the term “adherence” was proposed. The World Health Organisation (WHO) defines “adherence” as “the extent to which a person’s behaviour, including taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a healthcare pro-vider” [7]. Adherence has been also defined as the “active, voluntary, and collaborative involvement of the patient in a mutually acceptable course of behaviour to produce a therapeutic result” [8]. Previously the term ‘compliance’ was widely used, particularly in negative concord as ‘non-compliance’. Nowadays ‘compliance’ is associated with a more pejorative connotation than ‘adherence’ because ‘non-compliance issues’ are mostly patient-oriented without a deeper view into the different set of factors, e.g. obstacles identified in the healthcare system. Thus, currently in scientific deliberations we usually prefer usage of the term ‘adherence’ [9].

Get Citation

Keywords

Adherence, cardiovascular diseases, self-reported questionnaires

About this article
Title

Adherence to treatment — a pivotal issue in long-term treatment of patients with cardiovascular diseases. An expert standpoint

Journal

Medical Research Journal

Issue

Vol 2, No 4 (2017)

Pages

123-127

Published online

2018-03-30

DOI

10.5603/MRJ.2017.0016

Bibliographic record

Medical Research Journal 2017;2(4):123-127.

Keywords

Adherence
cardiovascular diseases
self-reported questionnaires

Authors

Aldona Kubica
Marcin Gruchała
Miłosz Jaguszewski
Piotr Jankowski
Damian Świeczkowski
Piotr Merks
Izabella Uchmanowicz

References (50)
  1. Navarese EP, Verdoia M, Schaffer A, et al. Ischaemic and bleeding complications with new, compared to standard, ADP-antagonist regimens in acute coronary syndromes: a meta-analysis of randomized trials. QJM. 2011; 104(7): 561–569.
  2. Tantry US, Jeong YH, Navarese EP, et al. Influence of genetic polymorphisms on platelet function, response to antiplatelet drugs and clinical outcomes in patients with coronary artery disease. Expert Rev Cardiovasc Ther. 2013; 11(4): 447–462.
  3. Kozinski M, Bielis L, Wisniewska-Szmyt J, et al. Diurnal variation in platelet inhibition by clopidogrel. Platelets. 2011; 22(8): 579–587.
  4. Kubica A, Kozinski M, Grzesk G, et al. Genetic determinants of platelet response to clopidogrel. J Thromb Thrombolysis. 2011; 32(4): 459–466.
  5. Kubica A, Koziński M, Grześk G, et al. [Clinical significance of interactions between clopidogrel and proton pump inhibitors]. Kardiol Pol. 2011; 69(6): 610–616.
  6. Latry P, Martin-Latry K, Lafitte M, et al. Dual antiplatelet therapy after myocardial infarction and percutaneous coronary intervention: analysis of patient adherence using a French health insurance reimbursement database. EuroIntervention. 2012; 7(12): 1413–1419.
  7. Sabate´ E. World Health Organization. Adherence to long-term therapies: evidence for action. http://www.who.int/chp/knowledge/publications/adherence_full_report.pdf.
  8. Ho PM, Tsai TT, Maddox TM, et al. Delays in filling clopidogrel prescription after hospital discharge and adverse outcomes after drug-eluting stent implantation: implications for transitions of care. Circ Cardiovasc Qual Outcomes. 2010; 3(3): 261–266.
  9. Ahmed R, Aslani P. What is patient adherence? A terminology overview. Int J Clin Pharm. 2014; 36(1): 4–7.
  10. 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.
  11. Kubica J, Adamski P, Buszko K, et al. Rationale and Design of the Effectiveness of LowEr maintenanCe dose of TicagRelor early After myocardial infarction (ELECTRA) pilot study. Eur Heart J Cardiovasc Pharmacother. 2017 [Epub ahead of print].
  12. Winter MP, Koziński M, Kubica J, et al. Personalized antiplatelet therapy with P2Y12 receptor inhibitors: benefits and pitfalls. Postepy Kardiol Interwencyjnej. 2015; 11(4): 259–280.
  13. Stewart K, Mc Namara KP, George J. Challenges in measuring medication adherence: experiences from a controlled trial. Int J Clin Pharm. 2014; 36(1): 15–19.
  14. 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.
  15. Zhu B, Zhao Z, McCollam P, et al. Factors associated with clopidogrel use, adherence, and persistence in patients with acute coronary syndromes undergoing percutaneous coronary intervention. Curr Med Res Opin. 2011; 27(3): 633–641.
  16. Wijns W, Kolh P, Danchin N, et al. Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS), European Association for Percutaneous Cardiovascular Interventions (EAPCI),. Guidelines on myocardial revascularization. Eur Heart J. 2010; 31(20): 2501–2555.
  17. Canpolat U, Yorgun H, Atalar E. Simultaneous subacute thrombosis of bare metal coronary stents in two different arteries early after clopidogrel cessation. Cardiol J. 2012; 19(3): 309–313.
  18. Jeremias A, Sylvia B, Bridges J, et al. Stent thrombosis after successful sirolimus-eluting stent implantation. Circulation. 2004; 109(16): 1930–1932.
  19. Iakovou I, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005; 293(17): 2126–2130.
  20. Kubica A, Kochman W, Bogdan M, et al. The influence of undergone percutaneous coronary interventions, and earlier hospitalizations with myocardial infarction on the level of knowledge and the effectiveness of health education in patients with myocardial infarction. Adv Interv Cardiol. 2009; 5: 25–30.
  21. Lam WY, Fresco P. Medication Adherence Measures: An Overview. Biomed Res Int. 2015; 2015: 217047.
  22. Yusuf S, Islam S, Chow CK, et al. Prospective Urban Rural Epidemiology (PURE) Study Investigators. Use of secondary prevention drugs for cardiovascular disease in the community in high-income, middle-income, and low-income countries (the PURE Study): a prospective epidemiological survey. Lancet. 2011; 378(9798): 1231–1243.
  23. Spertus JA, Kettelkamp R, Vance C, et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation. 2006; 113(24): 2803–2809.
  24. Kubica A, Obońska K, Fabiszak T, et al. Adherence to antiplatelet treatment with P2Y12 receptor inhibitors. Is there anything we can do to improve it? A systematic review of randomized trials. Curr Med Res Opin. 2016; 32(8): 1441–1451.
  25. 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.
  26. Holt EW, Rung AL, Leon KA, et al. Medication Adherence in Older Adults: A Qualitative Study. Educ Gerontol. 2014; 40(3): 198–211.
  27. Ferreira-González I, Marsal JR, Ribera A, et al. Double antiplatelet therapy after drug-eluting stent implantation: risk associated with discontinuation within the first year. J Am Coll Cardiol. 2012; 60(15): 1333–1339.
  28. Sengstock D, Vaitkevicius P, Salama A, et al. Under-prescribing and non-adherence to medications after coronary bypass surgery in older adults: strategies to improve adherence. Drugs Aging. 2012; 29(2): 93–103.
  29. Collins SD, Torguson R, Gaglia MA, et al. Does black ethnicity influence the development of stent thrombosis in the drug-eluting stent era? Circulation. 2010; 122(11): 1085–1090.
  30. Shimony A, Zahger D, Ilia R, et al. Impact of the community's socioeconomic status on characteristics and outcomes of patients undergoing percutaneous coronary intervention. Int J Cardiol. 2010; 144(3): 379–382.
  31. Ferreira-González I, Marsal JR, Ribera A, et al. Background, incidence, and predictors of antiplatelet therapy discontinuation during the first year after drug-eluting stent implantation. Circulation. 2010; 122(10): 1017–1025.
  32. Tuppin P, Neumann A, Danchin N, et al. Evidence-based pharmacotherapy after myocardial infarction in France: adherence-associated factors and relationship with 30-month mortality and rehospitalization. Arch Cardiovasc Dis. 2010; 103(6-7): 363–375.
  33. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005; 353(5): 487–497.
  34. Muntner P, Mann DM, Woodward M, et al. Predictors of low clopidogrel adherence following percutaneous coronary intervention. Am J Cardiol. 2011; 108(6): 822–827.
  35. Roth GA, Morden NE, Zhou W, et al. Clopidogrel use and early outcomes among older patients receiving a drug-eluting coronary artery stent. Circ Cardiovasc Qual Outcomes. 2012; 5(1): 103–112.
  36. Vrijens B, De Geest S, Hughes DA, et al. ABC Project Team. A new taxonomy for describing and defining adherence to medications. Br J Clin Pharmacol. 2012; 73(5): 691–705.
  37. DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004; 42(3): 200–209.
  38. Singh N, Squier C, Sivek C, et al. Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: prospective assessment with implications for enhancing compliance. AIDS Care. 1996; 8(3): 261–269.
  39. Bender BG, Rand C. Medication non-adherence and asthma treatment cost. Curr Opin Allergy Clin Immunol. 2004; 4(3): 191–195.
  40. Lehmann A, Aslani P, Ahmed R, et al. Assessing medication adherence: options to consider. Int J Clin Pharm. 2014; 36(1): 55–69.
  41. 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. Med Res J. 2016; 1(1): 37–42.
  42. Kane S, Shaya F. Medication non-adherence is associated with increased medical health care costs. Dig Dis Sci. 2008; 53(4): 1020–1024.
  43. Haynes RB, Yao X, Degani A, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev. 2005; 4: 26–33.
  44. 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 Adher. 2018; Volume 12: 333–340.
  45. 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.
  46. Jankowski P, Czarnecka D, Łukaszewska A, et al. Factors related to the effectiveness of hypercholesterolemia treatment following hospitalization for coronary artery disease. Pol Arch Med Wewn. 2016; 126(6): 388–394.
  47. Jankowska-Polańska B, Uchmanowicz I, Dudek K, et al. Relationship between patients' knowledge and medication adherence among patients with hypertension. Patient Prefer Adherence. 2016; 10: 2437–2447.
  48. Kubica A, Obońska K, Kasprzak M, et al. Prediction of high risk of non-adherence to antiplatelet treatment. Kardiol Pol. 2016; 74(1): 61–67.
  49. Swieczkowski D, Mogielnicki M, Merks P, et al. Pharmaceutical services as a tool to improve outcomes in patients with cardiovascular diseases. Int J Cardiol. 2016; 222: 238–241.
  50. Aslani P, Schneider MP. Adherence: the journey of medication taking, are we there yet? Int J Clin Pharm. 2014; 36(1): 1–3.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.