Top 3 Barriers to Cardiovascular Drug Adherence

Pharmacists can help evaluate and address adherence barriers among patients taking medications for cardiovascular disease (CVD).

Researchers from Duke University Medical Center recently determined which barriers prevented patients with CVD from taking their cardiac medications as prescribed and evaluated patient-level characteristics associated with those reported medication barriers.

They recruited a total of 428 patients with a mean age of 61 years who received care at primary care clinics. More than half of the patients were married or living with their partners, and 10% reported that they didn’t have someone to help with tasks if needed. The majority (85%) of the participants were men.

Around 64% of the patients were diagnosed with hypertension and hyperlipidemia, and 40% were diagnosed with diabetes.

The participants were instructed to complete a questionnaire in which they rated 7 questions about medication barriers on a scale from “definitely false” to “definitely true.”

Cardiovascular disease medication adherence over the past 30 days was also evaluated based on rating statements as true or false.

A few examples were:

• “When I feel better, I sometimes stop taking my medicine.”
• “If I feel worse when I take the medicine, sometimes I stop taking it.”
• “I am sometimes careless about taking my medicine.”

Asked directly which barriers they faced to taking their medications as prescribed, the participants most often gave the following reasons:

• They had too much medication to take (31%).
• They forgot whether medication had been taken at a particular time (24%).
• They didn’t have someone to help them keep track of when to take their medications (23%).

Few participants (3%) said their instructions for medications were too complicated. More than half of the patients endorsed at least 1 medication barrier.

Through further analysis, the researchers learned that patients who weren’t employed or didn’t have someone to help them complete tasks reported higher medication barrier scores.

Other factors that were associated with a higher medication barrier score included being younger at enrollment, nonwhite race, unmarried, having low health literacy, unemployment, and reporting inadequate financial status. Patients with both hypertension and hyperlipidemia also reported higher medication barrier scores than those diagnosed with only hypertension.

“Because we do not have a precise prediction tool to determine which patients experience problems with adherence, it may be important to screen patients for the presence of common medication adherence barriers,” the study authors concluded. “For common barriers such as having too much medicine to take or forgetting to take medications, there are myriad existing electronic tools available.”

Those tools could include health systems’ electronic health record systems that already inform medication reconciliation or medication reminders in the form of smartphone apps.

“Linking patients with existing resources of relevance to their specific barriers is critical to address problems and subsequently improve medication adherence,” the researchers concluded.

Their findings were published in the Journal of Managed Care & Specialty Pharmacy.