RT Journal Article
SR Electronic
T1 Medication Taking in Coronary Artery Disease: A Systematic Review and Qualitative Synthesis
JF The Annals of Family Medicine
JO Ann Fam Med
FD American Academy of Family Physicians
SP 224
OP 232
DO 10.1370/afm.1620
VO 12
IS 3
A1 Rashid, Mohammed A.
A1 Edwards, Duncan
A1 Walter, Fiona M.
A1 Mant, Jonathan
YR 2014
UL http://www.annfammed.org/content/12/3/224.abstract
AB PURPOSE Despite the compelling evidence supporting cardiovascular medications in the secondary prevention of coronary artery disease, many patients discontinue treatment. In this synthesis, we sought to understand from a patient perspective the factors that promote medication persistence. METHODS We systematically searched 7 databases (MEDLINE, Embase, PsycINFO, SCOPUS, CINAHL, ASSIA, and SSCI) for published qualitative research about the medication-taking experiences of patients with coronary artery disease and their partners. Articles were assessed for quality using a modified CASP (Critical Appraisal Skills Programme) checklist. Synthesis was undertaken using well-established meta-ethnographic approaches. RESULTS We included 17 articles in the final synthesis from the United Kingdom (6), Europe (5), United States (4), China (1), and Australia (1), with a total sample size of 391 patients. Analyses suggested that some patients hold fatalistic beliefs about their disease, whereas others believe they have been cured by interventions; both can lead to failure to take medication. Patients who adapt to being a “heart patient” are positive about medication taking. Some individuals dislike taking tablets generally and are wary of long-term effects. Relationships with prescribing clinicians are of critical importance for patients, with inaccessibility and insensitive terminology negatively affecting patients’ perceptions about treatments. CONCLUSIONS Strategies to promote higher persistence of secondary prevention medications in patients with coronary artery disease need to recognize the key role of the prescribing clinician. Providing medication-specific information at the time of initiating therapy, improving the transition between secondary and primary care, and explaining the risk of disease recurrence may all help to modify patient attitudes toward drugs to prevent further cardiovascular disease.