Skip to main content

Advertisement

SpringerLink
Log in

Awareness about barriers to medication adherence in cardiovascular patients and strategies used in clinical practice by Portuguese clinicians: a nationwide study

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background

Although much is known about cardiovascular patients’ medication adherence, the extent to which clinicians perceive non-adherence as a barrier in clinical practice is little explored. Objective To evaluate knowledge and awareness about potential barriers to medication adherence, and to evaluate strategies used in clinical practice by Portuguese clinicians on how to foster medication adherence of patients undergoing secondary cardiovascular prevention. Setting Nominal Group Technique (NGT) at the University of Lisbon; online survey addressed to physicians working in primary and secondary care in Portugal. Method A narrative literature review was conducted in Pubmed to identify studies describing interventions targeted at physicians to manage medication adherence. The NGT included 12 allied healthcare professionals with recognized expertise in medication adherence and was organised in four phases, resulting in survey development. The survey was used in a cross-sectional national study where clinicians reported their knowledge and perceptions about patients’ medication adherence and their daily practice. Main outcome measures Knowledge and awareness about barriers to medication adherence; and practice patterns. Results A total of 296 papers were identified, 26 of which were included. Four main topics were selected to be used in the NGT: adherence determinants, detecting non-adherence, fostering adherence, and educating physicians. NGT resulted in a survey, reaching 451 physicians, mostly practicing in primary care. Most had specific education on medication adherence and considered patient interviews and prescription records the most useful assessment methods. Nonetheless, many recognised often using clinical judgement to evaluate adherence in practice. Barriers to medication adherence were perceived to occur often during implementation. Most perceived reasons for uncontrolled hypertension were non-adherence to lifestyle recommendations and to medication. Less than half the physicians asked their patients if medication was taken. More useful enabling strategies included reducing daily doses, reviewing therapeutic options and motivational interventions. Conclusions Clinicians seem well informed about the importance of medication adherence and aware of problems encountered in practice. Limited time during medical appointment may be a barrier for better patient support.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Roth GA, Abate D, Abate KH, Abay SM, Abbafati C, Abbasi N, et al, on behalf of GBD 2017 Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1736–1788.

  2. World Health Organization. Global status report on noncommunicable diseases 2014: “Attaining the nine global noncommunicable diseases targets; a shared responsibility.” Geneva: World Health Organization; 2014.

    Google Scholar 

  3. Patnode CD, Evans CV, Senger CA, Redmond N, Lin JS. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without known cardiovascular disease risk factors: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;318(2):175–93.

    Article  Google Scholar 

  4. Parappilly BP, Field TS, Mortenson WB, Sakakibara BM, Eng JJ. Effectiveness of interventions involving nurses in secondary stroke prevention: a systematic review and meta-analysis. Eur J Cardiovasc Nurs. 2018;8(17):728–36.

    Article  Google Scholar 

  5. Alshehri AA, Jalal Z, Cheema E, Haque MS, Jenkins D, Yahyouche A. Impact of the pharmacist-led intervention on the control of medical cardiovascular risk factors for the primary prevention of cardiovascular disease in general practice: a systematic review and meta-analysis of randomised controlled trials. Br J Clin Pharmacol. 2020;86(1):29–38.

    Article  Google Scholar 

  6. Xu R, Xie X, Li S, Chen X, Wang S, Hu C, et al. Interventions to improve medication adherence among Chinese patients with hypertension: a systematic review and meta-analysis of randomized controlled trials. Int J Pharm Pract. 2018;26(4):291–301.

    Article  Google Scholar 

  7. Fuller RH, Perel P, Navarro-Ruan T, Nieuwlaat R, Haynes RB, Huffman MD. Improving medication adherence in patients with cardiovascular disease: a systematic review. Heart. 2018;104(15):1238–43.

    Article  Google Scholar 

  8. Palmer MJ, Barnard S, Perel P, Free C. Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults. Cochrane Database Syst Rev. 2018;6(6):CD012675.

    PubMed  Google Scholar 

  9. Martins SF, van Mil JWF, Alves da Costa F. The organizational framework of community pharmacies in Europe. Int J Clin Pharm. 2015;37(5):896–905.

    Article  CAS  Google Scholar 

  10. Soares IB, Imfeld-Isenegger TL, Makovec UN, Horvat N, Kos M, Arnet I, et al. A survey to assess the availability, implementation rate and remuneration of pharmacist-led cognitive services throughout Europe. Res Social Adm Pharm. 2020;16(1):41–7.

    Article  Google Scholar 

  11. Ministério da Saúde. Portaria n.º 97/2018. Diário da República n.º 69/2018, Série I de 2018-04-09. Defines pharmaceutical services to be made available in community pharmacies. https://data.dre.pt/eli/port/97/2018/04/09/p/dre/pt/html.

  12. Kulkarni J, Reeve-Parker K. Psychiatrists’ awareness of partial-and non-adherence to antipsychotic medication in schizophrenia: results from the Australian ADHES survey. Australas Psychiatry. 2015;23:258–64.

    Article  Google Scholar 

  13. Barfoed BL, Paulsen MS, Christensen PM, Halvorsen PA, Kjær T, Larsen ML, et al. Associations between patients’ risk attitude and their adherence to statin treatment—a population based questionnaire and register study. BMC Fam Pract. 2016;17:28.

    Article  Google Scholar 

  14. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52(6):377–84. https://doi.org/10.1136/jech.52.6.377.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Costa FA, Scullin C, Al-Taani G, Hawwa AF, Anderson C, Bezverhni Z, et al. Provision of pharmaceutical care by community pharmacists across Europe: is it developing and spreading? J Eval Clin Pract. 2017;23(6):1336–47.

    Article  Google Scholar 

  16. Clyne W, Mshelia C, McLachlan S, Jones P, De Geest S, Ruppar T, et al. A multinational cross-sectional survey of the management of patient medication adherence by European healthcare professionals. BMJ Open. 2016;6:e009610.

    Article  Google Scholar 

  17. R Development Core Team. R: a language and environment for statistical computing. Vienna, Austria. R Foundation for Statistical Computing, 2008. ISBN 3-900051-07-0.

  18. Vrijens B, DeGeest S, Hughes DA, Kardas P, Demonceau J, Ruppar T, et al. A new taxonomy for describing and defining dherence to medications. Brit J Clin Pharmacol. 2012;73:691–705.

    Article  Google Scholar 

  19. Nogueira JD. Duração da Consulta: Perspectivas dos Médicos e dos Pacientes. [Duration of the medical appointment: physicians and patients’ perspectives]. Rev Port Clin Geral. 2002;18:303–12.

    Google Scholar 

  20. Granja M, Ponte C, Cavadas LF. What keeps family physicians busy in Portugal? A multicentre observational study of work other than direct patient contacts. BMJ Open. 2014;4:e005026.

    Article  Google Scholar 

  21. Hauser K, Matthes J. Medical students’ medication communication skills regarding drug prescription—a qualitative analysis of simulated physician-patient consultations. Eur J Clin Pharmacol. 2017. https://doi.org/10.1007/s002.

    Article  PubMed  Google Scholar 

  22. Härtl A, Bachmann C, Blum K, Höfer S, Peters T, Preusche I, et al. Desire and reality—teaching and assessing communicative competencies in undergraduate medical education in German-speaking Europe—a survey. GMS Z Med Ausbild. 2015;32:Doc56.

    PubMed  PubMed Central  Google Scholar 

  23. Lavanya SH, Kalpana L, Veena RM, Bharath Kumar VD. Role-play as an educational tool in medication communication skills: students’ perspectives. Indian J Pharmacol. 2016;48:33–6.

    Article  Google Scholar 

  24. Costa FA, Pedro AR, Teixeira I, Bragança F, Silva JA, Cabrita J. Primary non-adherence in Portugal: findings and implications. Int J Clin Pharm. 2015;37:626–35.

    Article  Google Scholar 

  25. Blaschke TF, Osterberg L, Vrijens B, Urquhart J. Adherence to medications: insights arising from studies on the unreliable link between prescribed and actual drug dosing histories. Annu Rev Pharmacol Toxicol. 2012;52:275–301.

    Article  CAS  Google Scholar 

  26. Costa FA, Teixeira I, Duarte-Ramos F, Proença L, Pedro AR, Furtado C, Silva JA, Cabrita J. Effects of economic recession on elderly patients’ perceptions of access to health care and implications on their medicines-taking behaviour in Portugal. Int J Clin Pharm. 2016;39:104–12.

    Article  Google Scholar 

  27. Jeffery RA, Navarro T, Wilczynski NL, Iserman EC, Keepanasseril A, Sivaramalingam B, et al. Adherence measurement and patient recruitment methods are poor in intervention trials to improve patient adherence. J Clin Epidemiol. 2014;67(10):1076–82.

    Article  Google Scholar 

  28. Winters A, Esse T, Bhansali A, Serna O, Mhatre S, Sansgiry S. Physician perception of patient medication adherence in a cohort of medicine advantage plans in Texas. J Managed Care Spec Pharm. 2016;22:305–12.

    Article  Google Scholar 

  29. Makoul G, Arntson P, Schofield T. Health promotion in primary care: physician–patient communication and decision making about prescription medications. Soc Sci Med. 1995;41:1241–54.

    Article  CAS  Google Scholar 

  30. Stevenson FA, Barry CA, Britten N, Barber N, Bradley CP. Doctor–patient communication about drugs: the evidence for shared decision making. Soc Sci Med. 2000;50:829–40.

    Article  CAS  Google Scholar 

  31. Richard C, Lussier M-T. Nature and frequency of exchanges on medications during primary care encounters. Patient Educ Couns. 2006;64:207–16.

    Article  Google Scholar 

  32. Saba M, Diep J, Saini B, Dhippayom T. Meta-analysis of the effectiveness of smoking cessation interventions in community pharmacy. J Clin Pharm Ther. 2014;39(3):240–7.

    Article  CAS  Google Scholar 

  33. Um IS, Krass I, Armour C, Gill T, Chaar BB. Developing and testing evidence-based weight management in Australian pharmacies: a Healthier Life Program. Int J Clin Pharm. 2015;37(5):822–33.

    Article  Google Scholar 

  34. Milosavljevic A, Aspden T, Harrison J. Community pharmacist-led interventions and their impact on patients’ medication adherence and other health outcomes: a systematic review. Int J Pharm Pract. 2018;26(5):387–97.

    Article  Google Scholar 

Download references

Acknowledgements

To all the physicians who cooperated with this study by answering the survey.

Funding

The study was financed by Ferrer S.A.

Author information

Authors and Affiliations

  1. Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal

    João Aguiar & Filipa Alves da Costa

  2. Environmental and Natural Resources Center (CERENA), University of Lisbon, Higher Technical Institute, Lisbon, Portugal

    Manuel Ribeiro

  3. National School of Public Health, Nova University of Lisbon, Research Group in Health Policy and Administration, Lisbon, Portugal

    Ana Rita Pedro

  4. Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal

    Ana Paula Martins

  5. Interdisciplinary Research Center Egas Moniz (CiiEM), University Institute Egas Moniz (IUEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-511, Caparica, Portugal

    Filipa Alves da Costa

Authors
  1. João Aguiar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manuel Ribeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ana Rita Pedro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana Paula Martins
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Filipa Alves da Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Filipa Alves da Costa.

Ethics declarations

Conflicts of interest

FAC reports non-financial support from Bayer Global outside the submitted work. The remaining authors declare no conflicts of interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aguiar, J., Ribeiro, M., Pedro, A.R. et al. Awareness about barriers to medication adherence in cardiovascular patients and strategies used in clinical practice by Portuguese clinicians: a nationwide study. Int J Clin Pharm 43, 629–636 (2021). https://doi.org/10.1007/s11096-020-01174-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-020-01174-2

Keywords

Search

Navigation