Changes in Beliefs About Medications During Long-Term Care for IHD
Changes in Beliefs About Medications During Long-Term Care for IHD
Background Beliefs such as self-reported low necessity for medications and high concerns about medications are associated with nonadherence. Changes in these beliefs during long-term care have not previously been studied and were evaluated for purposes of this analysis.
Methods From January 2006 through September 2007, patients at 41 hospitals who met entry criteria for the CRUSADE Quality Improvement Initiative were consented for participation in a longitudinal follow-up survey study called MAINTAIN. The patients completed The Beliefs about Medicines Questionnaire at 3 and 12 months postdischarge to assess necessity and concerns related to heart medications. Internal reliability and construct validity of the survey were evaluated at both time points. Changes in necessity and concern scores from 3 to 12 months were determined, and factors associated with negative changes were explored.
Results A total of 812 patients completed both surveys. Internal reliability and construct validity were good. From 3 to 12 months, only 9.2% of patients shifted from a high to low necessity score; however, 20.7% of patients shifted from a low to high concern score. Factors found to be statistically significantly and independently associated with increased concern were the perception that the provider did not listen carefully to the patient (odds ratio [OR] 2.63, 95% CI 1.49–4.76), depression at 12 months (OR 2.95, 95% CI 1.57–5.55), hospital discharge with ≥7 medications (OR 1.71, 95% CI 1.07–2.74), and not receiving a medication list/instructions at hospital discharge (OR 1.69, 95% CI 1.05, 2.78). Factors associated with decreased necessity included not having a cardiologist (OR 2.26, 95% CI 1.34–3.83) and nonpersistence at 12 months with lipid-lowering medication (OR 1.85, 95% CI 1.01–3.45).
Conclusions One third of the patients reported a negative change in their beliefs about heart medications. Although some changes were observed in perceived necessity, negative changes in concerns occurred in 1 of every 5 patients. Interventions that address these concerns may be useful in improving adherence and clinical outcomes.
Many studies have demonstrated less than optimal long-term adherence to evidence-based medications for cardiovascular disease, which in turn has been associated with poor clinical outcomes. Despite the fact that patient-specific reasons for medication nonadherence are highly variable, it has been proposed that a patient's belief about his or her medications is one of the key predictors of medication nonadherence. These patient-specific beliefs drive day-to-day decisions in medication-taking behavior. The Beliefs about Medicines Questionnaire (BMQ) is a validated questionnaire, used primarily in clinical research, to assess these beliefs in several patient populations, including those with ischemic heart disease. Negative beliefs (greater concern or lower necessity) have been shown to be significantly associated with medication nonadherence. Nevertheless, previous studies have only done a single assessment of beliefs; and it is not known if patient's medication beliefs change during long-term medical management. Because many studies have shown a general decline in adherence during long-term management, understanding patient beliefs over time may be useful in improving long-term adherence.
To explore this question in patients with chronic ischemic heart disease, we administered the BMQ at 3 and 12 months after a hospital discharge for acute coronary syndrome (ACS). We assessed changes in patients' beliefs about heart medications. Patient characteristics and perceptions associated with changes toward more negative beliefs were determined.
Abstract and Introduction
Abstract
Background Beliefs such as self-reported low necessity for medications and high concerns about medications are associated with nonadherence. Changes in these beliefs during long-term care have not previously been studied and were evaluated for purposes of this analysis.
Methods From January 2006 through September 2007, patients at 41 hospitals who met entry criteria for the CRUSADE Quality Improvement Initiative were consented for participation in a longitudinal follow-up survey study called MAINTAIN. The patients completed The Beliefs about Medicines Questionnaire at 3 and 12 months postdischarge to assess necessity and concerns related to heart medications. Internal reliability and construct validity of the survey were evaluated at both time points. Changes in necessity and concern scores from 3 to 12 months were determined, and factors associated with negative changes were explored.
Results A total of 812 patients completed both surveys. Internal reliability and construct validity were good. From 3 to 12 months, only 9.2% of patients shifted from a high to low necessity score; however, 20.7% of patients shifted from a low to high concern score. Factors found to be statistically significantly and independently associated with increased concern were the perception that the provider did not listen carefully to the patient (odds ratio [OR] 2.63, 95% CI 1.49–4.76), depression at 12 months (OR 2.95, 95% CI 1.57–5.55), hospital discharge with ≥7 medications (OR 1.71, 95% CI 1.07–2.74), and not receiving a medication list/instructions at hospital discharge (OR 1.69, 95% CI 1.05, 2.78). Factors associated with decreased necessity included not having a cardiologist (OR 2.26, 95% CI 1.34–3.83) and nonpersistence at 12 months with lipid-lowering medication (OR 1.85, 95% CI 1.01–3.45).
Conclusions One third of the patients reported a negative change in their beliefs about heart medications. Although some changes were observed in perceived necessity, negative changes in concerns occurred in 1 of every 5 patients. Interventions that address these concerns may be useful in improving adherence and clinical outcomes.
Introduction
Many studies have demonstrated less than optimal long-term adherence to evidence-based medications for cardiovascular disease, which in turn has been associated with poor clinical outcomes. Despite the fact that patient-specific reasons for medication nonadherence are highly variable, it has been proposed that a patient's belief about his or her medications is one of the key predictors of medication nonadherence. These patient-specific beliefs drive day-to-day decisions in medication-taking behavior. The Beliefs about Medicines Questionnaire (BMQ) is a validated questionnaire, used primarily in clinical research, to assess these beliefs in several patient populations, including those with ischemic heart disease. Negative beliefs (greater concern or lower necessity) have been shown to be significantly associated with medication nonadherence. Nevertheless, previous studies have only done a single assessment of beliefs; and it is not known if patient's medication beliefs change during long-term medical management. Because many studies have shown a general decline in adherence during long-term management, understanding patient beliefs over time may be useful in improving long-term adherence.
To explore this question in patients with chronic ischemic heart disease, we administered the BMQ at 3 and 12 months after a hospital discharge for acute coronary syndrome (ACS). We assessed changes in patients' beliefs about heart medications. Patient characteristics and perceptions associated with changes toward more negative beliefs were determined.
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