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Medication non-adherence is prevalent in patients with CVD and is associated with adverse outcomes. Up to 25% of patients stop taking cardiovascular medicines after 6 months, and up to 47% of patients have stopped after 2 years.[#australian-pharmaceutical-advisory-council-apac.-2006]
Barriers to adherence include:
Strategies to improve adherence involve identifying and addressing potential barriers. The health professional’s approach influences how comfortable a patient is in providing a true report of adherence. Good interviewing techniques include a caring, non-judgemental approach and allowing enough time to discuss these issues. There are many ways to address barriers to adherence such as polypharmacy, physical impairment, side-effects, poor understanding and cost.
Complex regimen and frequent changes in treatment
Figure 1: Dose administration aids for patients
Weekly Dosette box
Reproduced with permission from www.forgettingthepill.com
Webster Pak®
Image courtesy of Webstercare. Webster-pak® is a registered trade mark of Manrex Pty Ltd
Physical impairments
Consider the appropriateness of dose formulation for administration (such as for swallowing difficulties)
Provide instructions in large print
Enlist the aid of a carer or family member in administering medications
Consider aids to open containers (e.g., medications blister pack opener, medical bottle openers, tablet cutters) when appropriate
Side effects
Common side effects from medicines used in secondary prevention of CAD include bleeding, bruising, dizziness, cough and muscle ache. Side effects from HF medications may include inconvenience of diuresis, fatigue and dizziness from beta-blockers, or dizziness and cough from ACEIs.
Diuretics can be administered in the morning and afternoon to minimise nocturia. Patients should not skip doses but may adjust the timing to avoid inconvenience when access to a toilet is limited.
Discuss the risk versus benefit of each medicine with the patient. Work in partnership with each patient to identify and manage potential side effects and to determine when a medical review is required.
Poor understanding
Poor understanding of the benefits of medications, for example, during the initiation and up-titration of beta-blocker therapy, may contribute to poor adherence as patients may experience symptoms such as dizziness and fatigue before noticing the benefits of therapy.
Cost
During dose up-titration of a medicine, multiple prescriptions for different strengths of the medicine may be required, which some patients may find a financial burden. Ensure patients are aware of any available government subsidies and advise them to discuss dose changes with their doctor before they decide to stop taking any medication. More cost-effective generic equivalents may be prescribed in cases where changes to a branded medicine will not cause any detrimental effects to the patient in terms of efficacy or safety or patient acceptance.
For more information see the National Heart Foundation of Australia Improving adherence in cardiovascular care toolkit.[#national-heart-foundation-of-australia-aslani-p-krass-i-bajorek-b-thistleth]