Nurse-Led Behaviour Change Interventions to Improve Medication Adherence in Patients with Cardiovascular Disease
- Publication Type:
- Thesis
- Issue Date:
- 2020
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๐๐ง๐ญ๐ซ๐จ๐๐ฎ๐๐ญ๐ข๐จ๐ง: Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with medication non-adherence a suboptimal, poorly prioritised and challenging health problem in both developed and developing nations. Treatment of CVD for most patients comprises lifelong lifestyle changes and regular medication. Adherence to recommended treatment can be promoted by nurse-led interventions.
๐๐ถ๐บ: The overarching aims of this thesis were to develop a widely-applicable, evidence-based nurse-led intervention tailored to address factors predictive of poor adherence to medication regimes in patients with CVD who had been admitted to an acute hospital as an acute cardiac care or those who attend cardiac rehabilitation, and to design a protocol to trial this intervention. Objectives were:
Paper 1: To critically appraise and synthesise the best available evidence on the effectiveness of interventions suitable for delivery by nurses, designed to enhance cardiac patientsโ adherence to their prescribed medications.
Paper 2: To identify factors predictive of medication adherence in patients with cardiovascular disease admitted or attending hospital in Australia.
Paper 3: To compare factors associated with medication non-adherence in patients with CVD in developed and developing nations (Australia and Iraq).
Paper 4: To design a protocol suitable to test the effectiveness of an evidence-based nurse-led intervention in promotion of medication adherence in patients with CVD who admit to in-patient for acute cardiac care or those who attend cardiac rehabilitation.
๐ ๐ฒ๐๐ต๐ผ๐ฑ๐: Using established methods, a systematic review was conducted to identify effective nurse-led medication adherence interventions for patients with CVD. Cross-sectional surveys were conducted with 120 and 126 patients with CVD who were inpatients of a cardiac ward or attending cardiac out-patient care in acute tertiary hospitals in Sydney, Australia and Baghdad, Iraq, respectively. Medication adherence was assessed using the Medication Adherence Questionnaire; factors potentially predictive of medication non-adherence were assessed using validated instruments and modelled using regression analysis. A pilot randomised controlled trial was proposed to test the hypothesis that a theory-based, nurse-led, multi-faceted intervention comprising motivational interviewing techniques and text message reminders can enhance medication adherence in cardiac patients compared to standard care alone.
๐ฅ๐ฒ๐๐๐น๐๐: Systematic review findings suggested that nurse-led interventions applying motivational interviewing and text messaging offer most promise. In the Australian study, participants from cardiac rehabilitation reported significantly lower adherence than ward in-patients. The comparative study showed significantly poorer adherence to cardiac medications in Iraqi than Australian patients. The ability to correctly self-administer and refill medications, and beliefs about medications, independently predicted cardiac medication adherence behaviour in both countries.
๐๐ผ๐ป๐ฐ๐น๐๐๐ถ๐ผ๐ป: Nurse-led interventions that incorporate elements of motivational interviewing plus text messaging have the potential to improve medication adherence of patients with CVD through targeting patientsโ ability to self-administer and refill medications and their beliefs about these medications.
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