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CARDIAC REHABILITATION PATIENTS' PERSPECTIVES ON CONCORDANCE AND COMPLIANCE WITH MEDICINES; A QUALITATIVE FOLLOW-UP STUDY
White S, Anderson C, Bissell P
Centre for Pharmacy, Health and Society. School of Pharmacy. University of Nottingham, Nottingham NG7 2RD
paxsjl@nottingham.ac.uk

Background
Hospital-based Cardiac Rehabilitation (CR) programmes offer eligible Coronary Heart Disease (CHD) patients physical exercise and education on a range of issues including lifestyle modification and medicines, which is intended to improve compliance. Compliance with statin therapy, for example, has been found to substantially reduce over time in patients with CHD1 and a qualitative study of CR patients found that compliance with lifestyle modification decreased over time2. However previous qualitative studies have not specifically explored changes over time of CR patients’ perspectives on use of medicines. Therefore this qualitative study aims to follow a group of CR patients over time and explore their perspectives on concordance and compliance with medicines.

 

Method

Following ethics committee approval for the study in-depth, audiotaped interviews were conducted with 16 CR patients around the time that they were attending the CR programme. In some cases a carer was present in the interview. Interview topics included experiences of CHD, experiences with medicines, sources of medicines information and education and experiences of pharmacists. Follow-up interviews were conducted approximately nine months later. Interview topics included ongoing experiences of CHD, ongoing access of services or patient groups, perspectives on risk of further CHD related events, concordance and compliance with medicines. Transcripts were analysed by constant comparison.

Results 
Findings indicate that these patients perceived heart attacks to be acute events that they were recovering from and did not see themselves as suffering from a chronic disease (i.e. CHD). Patients demonstrated a positive attitude towards compliance with medicines, which was shown in three ways: by saying that they took their medicines, by establishing routines to ensure they didn’t forget to take their medicines and by use of compliance aids. Compliance with medicines did not appear to reduce over time although compliance with lifestyle modification varied and some patients reported in follow up interviews that they were less compliant with lifestyle modification than at the time of the initial interview. Little evidence of concordance was found at either initial or follow-up interviews. 

Discussion
These CR patients had adopted and maintained a highly compliant approach to taking medicines over a period of approximately one year after discharge from hospital. However compliance with lifestyle modification was more variable and appears to decline over time, as found in previous research. Concordance does not seem to be an approach taken by health professionals or CR patients. This paper will further discuss themes surrounding concordance and compliance in CR patients.

References

  1. Tolmie E, Lindsay G, Kerr S, Brown M, Ford I, Gaw A. Patients’ perspectives on statin therapy for treatment of hypercholesterolaemia: a qualitative study. Eur J Cardiovasc Nurs 2003; 2: 141-149.
  2. Wiles R. Patient’s perceptions of their heart attack and recovery: the influence of epidemiological "evidence" and personal experience. Soc Sci Med 1988; 46: 1477-1486.
Presented at the HSRPP Conference 2005, Reading