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Kovoor JG, Chow CK, Salam A, Webster R, Shiel L, Nelson MR, Affandi JS, Hay P, Burke M, Figtree GA, Usherwood T, Reid CM, Schlaich MP, Rodgers A, Atkins ER. Participants' views of ultra-low dose combination therapy for high blood pressure: a mixed-methods study from the QUARTET trial. J Hum Hypertens 2024; 38:516-522. [PMID: 38744907 PMCID: PMC11166564 DOI: 10.1038/s41371-024-00915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/19/2024] [Accepted: 04/22/2024] [Indexed: 05/16/2024]
Abstract
Single-pill combination therapy containing four quarter-dose medications for high blood pressure improves BP control compared to monotherapy, however patient-reported acceptance of the quadpill as a treatment strategy remains undescribed. We collected within-trial feedback and interviewed participants from the quadruple ultra-low-dose treatment for hypertension (QUARTET) trial to characterise patient attitudes to this intervention. All trial participants were asked about ease and preference for the quadpill and provided an opportunity to give further comments on the trial at 12 weeks (trial primary endpoint) and 52 weeks extended follow-up. Separately, we used purposive and quota sampling for the semi-structured telephone interviews, with the resultant verbatim transcripts analysed using an inductive thematic analysis approach. Themes were re-evaluated after each successive interview, and at suspected data saturation, an additional interview conducted for confirmation. At 12 weeks follow-up, 502 of 591 (85%) participants responded to acceptability questions, and 359 of 417 (86%) responded at week 52. Most reported the trial capsule easy or very easy to take. From eight sites, 16 participants were interviewed between 5 August 2020 and 19 November 2020. All described a positive experience, preferred once-daily morning dosing and found routine facilitated adherence. Participants valued individual responsibility for adherence, and involvement of the general practitioner in blood-pressure management. Most reported capsule size did not deter adherence but desired a smaller capsule. Participants described a preference for minimising number and dosage of medications, reduced capsule size, and once-daily morning dosing. These findings suggest a preference for single-pill combination therapy for blood pressure lowering.
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Affiliation(s)
- Joshua G Kovoor
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Ballarat Base Hospital, Ballarat, VIC, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Westmead Hospital, Sydney, NSW, Australia
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Abdul Salam
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- The George Institute for Global Health, Hyderabad, Telangana, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Ruth Webster
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
- School of Population Health, UNSW, Sydney, NSW, Australia
| | - Louise Shiel
- School of Public Health and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Jacquita S Affandi
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Peter Hay
- Castle Hill Medical Centre, Sydney, NSW, Australia
| | | | - Gemma A Figtree
- Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia
- Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | - Tim Usherwood
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Christopher M Reid
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School - Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, WA, Australia
| | - Anthony Rodgers
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia
| | - Emily R Atkins
- The George Institute for Global Health, UNSW, Sydney, NSW, Australia.
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Geraghty JR, Testai FD. Advances in neurovascular research: Scientific highlights from the 15th world stroke congress. J Stroke Cerebrovasc Dis 2024; 33:107617. [PMID: 38307467 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/04/2024] Open
Affiliation(s)
- Joseph R Geraghty
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - Fernando D Testai
- Department of Neurology & Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
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Geraghty JR, Testai FD. WITHDRAWN: Advances in Neurovascular Research: Scientific Highlights from the 15 th World Stroke Congress. J Stroke Cerebrovasc Dis 2024:107614. [PMID: 38301748 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2024.107614. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.
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Affiliation(s)
- Joseph R Geraghty
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Fernando D Testai
- Department of Neurology & Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
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Murphy A, Willis R, Ansbro É, Masri S, Kabbara N, Dabbousy T, Bahous S, Molfino L, Perel P, Boulle P. Implementation of fixed-dose combination therapy for secondary prevention of atherosclerotic cardiovascular disease among Syrian refugees in Lebanon: a qualitative evaluation. BMC Health Serv Res 2022; 22:744. [PMID: 35659222 PMCID: PMC9167520 DOI: 10.1186/s12913-022-08040-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background We report findings of a qualitative evaluation of fixed-dose combination therapy for patients with established atherosclerotic cardiovascular disease (ASCVD) attending Médecins Sans Frontières (MSF) clinics in Lebanon. Cardiovascular disease is a leading cause of death and disability worldwide, and humanitarian actors are increasingly faced with the challenge of providing care for chronic diseases such as ASCVD in settings where health systems are disrupted. Secondary prevention strategies, involving 3–5 medications, are known to be effective for patients at risk of heart attack or stroke, but supply and adherence are challenging in humanitarian settings. Fixed dose combination therapy, combining two or more medications in one tablet, may be a strategy to address this. Methods The evaluation was nested within a prospective mixed-methods study in which eligible ASCVD patients were followed for 1 year during (i) 6 months of usual care then (ii) 6 months of fixed dose combination (FDC) therapy. After 1 year, we conducted in-depth interviews with a purposive sample of patients, MSF staff and external stakeholders. Interviews focused on acceptability and sustainability of the fixed dose therapy intervention. Interview data were analysed thematically, informed by thea Theoretical Framework of Acceptability. Additional attention was paid to non-typical cases in order to test and strengthen analysis. Results Patients and health care providers were positive about the FDC intervention. For patients, acceptability was related to ease of treatment and trust in MSF staff, while, for staff, it was related to perceived improvements in adherence, having a good understanding of the medication and its use, and fitting well with their priorities for patient’s wellbeing. External stakeholders were less familiar with FDC therapy. While external clinicals expressed concerns about treatment inflexibility, non-clinician stakeholder interviews suggested that cost-effectiveness would have a major influence on FDC therapy acceptability. Sustainability was tied to the future role of MSF care provision and coherence with the local health system. Conclusions For patients and clinic staff, FDC was an acceptable treatment approach for secondary prevention of ASCVD disease in two MSF clinics in Lebanon. Sustainability is more complex and calls for better alignment of care with public systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08040-z.
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Khan AA, Siddiqui SA, Yasmin F, Abidi SM, Tariq R, Ahmed H, Murtaza N, Jawed F, Lashkerwala SS, Moin A, Shah SMI, Ullah I, Yousaf Z, Faizan M, Shahid MH. The Era of Polypills in the Management of Cardiovascular Diseases: Are We There Yet? Curr Probl Cardiol 2022:101233. [PMID: 35490770 DOI: 10.1016/j.cpcardiol.2022.101233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/24/2022] [Indexed: 11/03/2022]
Abstract
Cardiovascular Diseases (CVD) are the leading cause of mortality globally. Wald and Law proposed the idea of a 'polypill'; a fixed dose combination therapy (FDC) in the form of a single pill to curb the CVD epidemic. Such a drug would include the combination of a broad spectrum of drugs including cholesterol lowering drugs, antihypertensive drugs, anti-platelet drugs, anti-coagulation drugs, anti-arrhythmic drugs, which are frequently integrated to combat specific CVDs. This 'polypill' holds the potential to pose several advantages like increased compliance, improved quality of life, risk factor control, psychological relief, and cost effectiveness along with minimal side effects. Several trials (like TIPS, UMPIRE, PolyIran etc.) have tested different treatment strategies to test the hypothesis of Wald and Law. Unlike the past physicians are now highly aware of this new strategy.The future of polypill in the management of CVD lies in a strategy where polypills are treated supplementary to the already existing preventive care, which includes lifestyle modifications and efforts to reduce tobacco use.
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Affiliation(s)
- Arsalan Aamir Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Farah Yasmin
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Rabbia Tariq
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Hiba Ahmed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Noor Murtaza
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Fareeha Jawed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Ariba Moin
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Irfan Ullah
- Department of Internal Medicine, Kabir Medical College, Gandhara University, Peshawar, Pakistan.
| | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Muhammad Faizan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
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Lehmann J, Riedl D, Sztankay M, Boehme C, Fischnaller J, Kiechl S, Holzner B, Knoflach M, Rumpold G. The Attitude towards Polypills Questionnaire (APPQ): a phase I-III development and validation study in patients with cerebrovascular disease. Eur J Neurol 2021; 28:4039-4050. [PMID: 34463018 PMCID: PMC9292587 DOI: 10.1111/ene.15088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE The polypill approach has been proposed to reduce patients' pill burden, increase medication adherence and lower stroke incidence. However, little is known about patients' attitudes towards polypills for cerebrovascular medication. METHODS Based on the European Organization for Research and Treatment of Cancer Quality of Life Group questionnaire development guidelines, a questionnaire to measure patients' attitudes towards polypills for the secondary prevention of stroke (phase I-III) was developed. In phase I, issues were generated via literature review and interviews with patients and healthcare professionals. The issues were operationalized into items in phase II. In phase III the questionnaire was validated in a large single-centre sample, and test-retest and internal validity were evaluated. RESULTS In phase I, 34 relevant issues were identified through literature search and interviews. Pre-testing the questionnaire indicated high applicability and comprehensibility. The final Attitudes towards Polypills Questionnaire was tested in N = 260 patients and showed a two-factor structure. The factors were labelled 'concerns' and 'benefits'. The scales showed acceptable and good internal validity (concerns, Cronbach's α = 0.85; benefits, α = 0.93), but the scales' test-retest validity was ambiguous. On a 0 to 3 rating scale, concerns were rated lower than benefits (mean 1.07, SD 0.69 vs. mean 1.87, SD 0.89). CONCLUSIONS The Attitudes towards Polypills Questionnaire showed high comprehensibility and content validity to assess German language patients' attitudes towards a polypill medication. Our data and questionnaire may aid the implementation of polypill treatments in clinical practice and can be used in the design of future clinical trials on polypill therapy. Further validation of the questionnaire is advised.
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Affiliation(s)
- Jens Lehmann
- University Hospital of Psychiatry IIMedical University of InnsbruckInnsbruckAustria
| | - David Riedl
- University Clinic of Medical PsychologyMedical University of InnsbruckInnsbruckAustria
| | - Monika Sztankay
- University Hospital of Psychiatry IIMedical University of InnsbruckInnsbruckAustria
| | - Christian Boehme
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Stefan Kiechl
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
- VASCage—Research Centre on Vascular Ageing and StrokeInnsbruckAustria
| | - Bernhard Holzner
- University Hospital of Psychiatry IMedical University of InnsbruckInnsbruckAustria
- Evaluation Software Development GmbHInnsbruckAustria
| | - Michael Knoflach
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
- VASCage—Research Centre on Vascular Ageing and StrokeInnsbruckAustria
| | - Gerhard Rumpold
- University Clinic of Medical PsychologyMedical University of InnsbruckInnsbruckAustria
- Evaluation Software Development GmbHInnsbruckAustria
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Preventing the Next Pandemic: The Case for Investing in Circulatory Health - A Global Coalition for Circulatory Health Position Paper. Glob Heart 2021; 16:66. [PMID: 34692391 PMCID: PMC8516006 DOI: 10.5334/gh.1077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) has had a continuous and robust impact on world health. The resulting COVID-19 pandemic has had a devastating physical, mental and fiscal impact on the millions of people living with noncommunicable diseases (NCDs). In addition to older age, people living with CVD, stroke, obesity, diabetes, kidney disease, and hypertension are at a particularly greater risk for severe forms of COVID-19 and its consequences. Meta-analysis indicates that hypertension, diabetes, chronic kidney disease, and thrombotic complications have been observed as both the most prevalent and most dangerous co-morbidities in COVID-19 patients. And despite the nearly incalculable physical, mental, emotional, and economic toll of this pandemic, forthcoming public health figures continue to place cardiovascular disease as the number one cause of death across the globe in the year 2020. The world simply cannot wait for the next pandemic to invest in NCDs. Social determinants of health cannot be addressed only through the healthcare system, but a more holistic multisectoral approach with at its basis the Sustainable Development Goals (SDGs) is needed to truly address social and economic inequalities and build more resilient systems. Yet there is reason for hope: the 2019 UN Political Declaration on UHC provides a strong framework for building more resilient health systems, with explicit calls for investment in NCDs and references to fiscal policies that put such investment firmly within reach. By further cementing the importance of addressing circulatory health in a future Framework Convention on Emergency Preparedness, WHO Member States can take concrete steps towards a pandemic-free future. As the chief representatives of the global circulatory health community and patients, the Global Coalition for Circulatory Health calls for increased support for the healthcare workforce, global vaccine equity, embracing new models of care and digital health solutions, as well as fiscal policies on unhealthy commodities to support these investments.
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Ho WY, Abdul-Rahim AH, Dawson J, Cameron AC. The role of single pill combination therapy in the prevention of ischaemic stroke. Scott Med J 2019; 64:126-132. [PMID: 31551045 DOI: 10.1177/0036933019876155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS The role of single pill combination therapy for stroke prevention remains to be established. We explored the perspectives of stroke survivors and healthcare professionals on single pill combination therapy for stroke prevention. METHODS We conducted focus groups involving stroke survivors and healthcare professionals. RESULTS We recruited six stroke survivors: four (67%) were female and mean age was 70 ± 12 years; and eight healthcare professionals (three Stroke Consultants, two Nurse Specialists, three General Practitioners). Improved adherence is the main perceived benefit of single pill combination therapy, although concerns exist surrounding less individualised care, unsuitability for use in the acute setting, reduced ability to titrate doses and difficulty identifying the cause of side effects. The clinical stability of patients, alongside single pill combination therapy efficacy, cost, side effect profile and evidence base for impact on risk factors and clinical outcomes are key factors influencing acceptability. Stroke survivors and healthcare professionals feel single pill combination therapy is most suitable for stable patients, although there is no evidence base for its use in this context. CONCLUSION Stroke healthcare professionals and stroke survivors are most amenable to using single pill combination therapy for stable patients, although its role in this context should be evaluated in studies with risk factor targets and clinical outcomes as endpoints.
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Affiliation(s)
- Wan Y Ho
- Medical Student, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Azmil H Abdul-Rahim
- Clinical Lecturer in Neurology, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Jesse Dawson
- Professor of Stroke Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Alan C Cameron
- Specialty Registrar and Honorary Clinical Lecturer, College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
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Patient beliefs and attitudes to taking statins: systematic review of qualitative studies. Br J Gen Pract 2019; 68:e408-e419. [PMID: 29784867 DOI: 10.3399/bjgp18x696365] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/24/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Statins are effective in preventing cardiovascular disease (CVD) events and are recommended for at-risk individuals but estimated adherence rates are low. AIM To describe patients' perspectives, experiences, and attitudes towards taking statins. DESIGN AND SETTING Systematic review of qualitative studies reporting perspectives of patients on statins. METHOD PsycINFO, CINAHL, Embase, MEDLINE, and PhD dissertations from inception to 6 October 2016 were searched for qualitative studies on adult patients' perspectives on statins. All text and participant quotations were extracted from each article and analysed by thematic synthesis. RESULTS Thirty-two studies involving 888 participants aged 22-93 years across eight countries were included. Seven themes were identified: confidence in prevention (trust in efficacy, minimising long-term catastrophic CVD, taking control, easing anxiety about high cholesterol); routinising into daily life; questioning utility (imperceptible benefits, uncertainties about pharmacological mechanisms); medical distrust (scepticism about overprescribing, pressure to start therapy); threatening health (competing priorities and risks, debilitating side effects, toxicity to body); signifying sickness (fear of perpetual dependence, losing the battle); and financial strain. CONCLUSION An expectation that statins could prevent CVD and being able to integrate the statin regimen in daily life facilitated acceptance of statins among patients. However, avoiding the 'sick' identity and prolonged dependence on medications, uncertainties about the pharmacological mechanisms, risks to health, side effects, costs, and scepticism about clinicians' motives for prescribing statins were barriers to uptake. Shared decision making that addresses the risks, reasons for prescribing, patient priorities, and implementing strategies to minimise lifestyle intrusion and manage side effects may improve patient satisfaction and continuation of statins.
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Qadi O, Marshall T, Adderley N, Bem D. Patients' and health professionals' attitudes and perceptions towards the initiation of preventive drugs for primary prevention of cardiovascular disease: protocol for a systematic review of qualitative studies. BMJ Open 2019; 9:e025587. [PMID: 30975677 PMCID: PMC6500290 DOI: 10.1136/bmjopen-2018-025587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Lipid-lowering drugs and antihypertensive agents can be prescribed for the primary prevention of cardiovascular disease. In some cases, patients eligible for primary prevention of cardiovascular disease according to the European guidelines are not always started on preventive drugs. Existing research explores the attitudes of health professionals and patients towards cardiovascular preventive drugs but does not always differentiate between the attitudes towards drug initiation for primary or secondary prevention. We aim to systematically review qualitative studies assessing health professionals' and patients' attitudes and perceptions towards drug initiation for primary prevention of cardiovascular disease. METHODS AND ANALYSIS MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, CINAHL, Applied Social Sciences Index and Abstracts, Conference Proceedings Citation Index (Web of Science), Healthcare Management Information Consortium, and Open Grey will be searched without restrictions on date or language of publication. Searches will be limited to studies of qualitative design, standalone or in the context of a mixed-method design, focusing on cardiovascular drug initiation for primary prevention. The primary outcome is the attitudes of health professionals and patients towards drug initiation for primary prevention of cardiovascular disease. Two reviewers will independently carry out the study selection, data extraction and quality assessment. The Critical Appraisal Skills Programme Qualitative Research Checklist will be used to assess the quality of included studies. The findings will be analysed using Thomas and Harden's thematic synthesis approach. ETHICS AND DISSEMINATION This systematic review does not require ethical approval as primary data will not be collected. The results of the study will be published in a peer-reviewed journal and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42018095346.
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Affiliation(s)
- Olla Qadi
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Nicola Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
| | - Danai Bem
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
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Kvarnström K, Airaksinen M, Liira H. Barriers and facilitators to medication adherence: a qualitative study with general practitioners. BMJ Open 2018; 8:e015332. [PMID: 29362241 PMCID: PMC5786122 DOI: 10.1136/bmjopen-2016-015332] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND General practitioners (GPs) manage the drug therapies of people with chronic diseases, and poor adherence to medication remains a major challenge. OBJECTIVE This qualitative study examined GPs' insights into non-adherence and ways of overcoming this problem. METHODS We ran four focus groups comprising 16 GPs at the Kirkkonummi Health Centre (Southern Finland). Interviews were audiotaped, transcribed verbatim and analysed by inductive content analysis. MAIN RESULTS The two main themes in the discussions with the GPs were non-adherence in the care of chronic disease and increased need for medicine information. The medication management challenges identified were related to: patient-specific factors, the healthcare system, characteristics of drug therapies and the function and role of healthcare professionals as a team. To improve the situation, the GPs offered a number of solutions: improved coordination of care, better patient education and IT systems as well as enhanced interprofessional involvement in the follow-up of patients. DISCUSSION AND CONCLUSIONS With an ageing population, the GPs were increasingly confronted with non-adherence in the care of chronic diseases. They had mostly a positive attitude towards organising care in a more interprofessional manner. To support medication adherence and self-management, the GPs appreciated pharmacists' assistance especially with patients with polypharmacy and chronic diseases.
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Affiliation(s)
- Kirsi Kvarnström
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Finland
| | - Helena Liira
- General Practice, School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
- Department of General Practice and Primary Health Care, Helsinki University Central Hospital, University of Helsinki, Finland
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Kassavou A, Sutton S. Reasons for non-adherence to cardiometabolic medications, and acceptability of an interactive voice response intervention in patients with hypertension and type 2 diabetes in primary care: a qualitative study. BMJ Open 2017; 7:e015597. [PMID: 28801402 PMCID: PMC5724082 DOI: 10.1136/bmjopen-2016-015597] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES This study explored the reasons for patients' non-adherence to cardiometabolic medications, and tested the acceptability of the interactive voice response (IVR) as a way to address these reasons, and support patients, between primary care consultations. DESIGN, METHOD, PARTICIPANTS AND SETTING The study included face-to-face interviews with 19 patients with hypertension and/or type 2 diabetes mellitus, selected from primary care databases, and presumed to be non-adherent. Thirteen of these patients pretested elements of the IVR intervention few months later, using a think-aloud protocol. Five practice nurses were interviewed. Data were analysed using multiperspective, and longitudinalthematic analysis. RESULTS Negative beliefs about taking medications, the complexity of prescribed medication regimens, and the limited ability to cope with the underlying affective state, within challenging contexts, were mentioned as important reasons for non-adherence. Nurses reported time constraints to address each patient's different reasons for non-adherence, and limited efficacy to support patients, between primary care consultations. Patients gave positive experiential feedback about the IVR messages as a way to support them take their medicines, and provided recommendations for intervention content and delivery mode. Specifically, they liked the voice delivering the messages and the voice recognition software. For intervention content, they preferred messages that were tailored, and included messages with 'information about health consequences', 'action plans', or simple reminders for performing the behaviour. CONCLUSIONS Patients with hypertension and/or type 2 diabetes, and practice nurses, suggested messages tailored to each patient's reasons for non-adherence. Participants recommended IVR as an acceptable platform to support adherence to cardiometabolic medications between primary care consultations. Future studies could usefully test the acceptability, and feasibility, of tailored IVR interventions to support medication adherence, as an adjunct to primary care.
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Affiliation(s)
- Aikaterini Kassavou
- Behavioural Science Group, Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Stephen Sutton
- Behavioural Science Group, Department of Public Health and Primary Care, The Primary Care Unit, University of Cambridge, Cambridge, UK
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13
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Webster R, Castellano JM, Onuma OK. Putting polypills into practice: challenges and lessons learned. Lancet 2017; 389:1066-1074. [PMID: 28290996 DOI: 10.1016/s0140-6736(17)30558-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 12/30/2022]
Abstract
Regulatory approvals for cardiovascular polypills are increasing rapidly across more than 30 countries. The evidence clearly shows polypills improve adherence and cardiovascular disease risk factors for patients with indications for use of polypill components-ie, those with established cardiovascular disease or at high risk. However, the implementation of polypills into clinical practice has many challenges. The clinical trials literature provides insights into the clinical impact of a polypill strategy, including cost-effectiveness, safety of use, substantial improvement in adherence, and better risk factor control than usual care. Despite the clear need for such a strategy and the available clinical data backing up the use of the polypill in different patient populations, challenges to widespread implementation, such as an absence of government reimbursement and poor physician uptake (identified from on the ground experience in countries following commercial rollout), have greatly obstructed real-world implementation. Obtaining the full public health benefit of polypills will require education, advocacy, endorsement, and implementation by key global agencies such as WHO and national clinical bodies, as well as endorsement from governments.
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Affiliation(s)
- Ruth Webster
- George Institute for Global Health, University of Sydney, Sydney, Australia.
| | - Jose M Castellano
- National Center for Cardiovascular Research, Carlos III Institute of Health, Madrid, Spain; Monteprincipe University Hospital, HM Group, Madrid, Spain; CEU San Pablo School of Medicine, San Pablo, Madrid, Spain
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