Page 925 - Cardiac Nursing

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C HAPTER 4 0 / Adherence to Cardiovascular Treatment Regimens 901
Acknowledgment: The authors were supported by grant 5RO1
SUMMARY DK071817, National Institute of Health, National Institute of Diabetes,
Digestive,and Kidney Disorders.
Inadequate adherence to the recommended treatment plan re-
mains a significant, ubiquitous problem facing health care pro- R EFERENCES
fessionals in all settings and populations worldwide. Research
has demonstrated the efficacy of pharmacological and behavioral 1.Burke, L. E., Dunbar-Jacob, J. M., & Hill, M. N. (1997). Compliance
treatment for an array of conditions. However, a wide separation with cardiovascular disease prevention strategies: A review of the re-
search. Annals of Behavioral Medicine, 19(3), 239–263.
exists between evidence-based recommendations and the actual 2.Burke, L. E., & Ockene, I. S. (2001). Compliance in healthcare and re-
treatment being prescribed. 141 This gap reflects providers not search. Armonk, NY: Futura.
recognizing patients’ need for treatment, not prescribing the 3.Sackett, D. L., & Haynes, R. B. (1976). Compliance with therapeutic reg-
imens. Baltimore: The Johns Hopkins University Press.
best drug or dose, and not involving the patient in the choice of 4. Sackett, D. L., & Snow, J. C. (1979). The magnitude of adherence and
treatment. Moreover, the effectiveness of the treatments that nonadherence. In R. B. Haynes, D. W. Taylor, & D. L. Sackett (Eds.),
have been prescribed has been undermined by less than ideal ad- Compliance in health care (pp. 11–22). Baltimore: Johns Hopkins Uni-
herence. Progress has been made in the measurement of adher- versity Press.
ence and in identifying strategies that may enhance adherence. 5. Horne, R. (2006). Compliance, adherence, and concordance: Implica-
tions for asthma treatment. Chest, 130(1, Suppl.), 65S–72S.
However, measurement methods remain limited and some are 6. Tilson, H. H. (2004). Adherence or compliance? Changes in terminol-
unaffordable or impractical for widespread clinical use. The sim- ogy. Annals of Pharmacother, 38(1), 161–162.
ple measures that exist may be as revealing (e.g., asking the pa- 7. Whellan, D. J., & Hamad, E. (2007). Natural history, adherence, or ia-
tient directly how often he or she does not perform a behavior trogenic insult: Repeat hospitalizations as a predictor of survival. Ameri-
can Heart Journal, 154(2), 203–205.
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or monitoring appointment nonattendance) but often are not 8. Clark, R. A., Inglis, S. C., McAlister, F. A., et al. (2007). Telemonitoring
used or heeded. Although research is ongoing on strategies to or structured telephone support programmes for patients with chronic
improve adherence, there remains a huge gap between what is heart failure: Systematic review and meta-analysis. BMJ, 334(7600), 942.
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known and beneficial and what is applied in clinical practice. 9. McAlister, F. A., Stewart, S., Ferrua, S., et al. (2004). Multidisciplinary
Thus, the poor rates of adherence have remained relatively strategies for the management of heart failure patients at high risk for ad-
static. 76,117,118 mission: A systematic review of randomized trials. Journal of the Ameri-
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can College of Cardiology, 44(4), 810–819.
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Not only are the intervention strategies applied in the clinical 10. Osterberg, L., & Blaschke, T. F. (2005). Adherence to medication. New
setting not enough to significantly affect adherence, but some in- England Journal of Medicine, 353(5), 487–497.
terventions are labor intensive and thus not easily implemented in 11. Brookhart, M. A. P. A., Schneeweiss, S., Avorn, J., et al. (2007). Physi-
a practice setting. Furthermore, the nurse faces additional chal- cian follow-up and provider continuity are associated with long-term
medication adherence: A study of the dynamics of statin use. Archives of
lenges because of the changing health care environment, includ- Internal Medicine, 167(8), 847–852.
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ing shortened length of hospital stay, increased level of acuity of 12. DiMatteo, M. R. (2004). Variations in patients’ adherence to medical
patients during their hospitalization and at discharge, reduced recommendations: A quantitative review of 50 years of research [see com-
number of visits after acute events, and increasingly complex ment]. Medical Care, 42(3), 200–209.
treatment regimens that patients need to learn how to implement. 13. Lowry, K. P., Dudley, T. K., Oddone, E. Z., et al. (2005). Intentional and
unintentional nonadherence to antihypertensive medication. The Annals
However, the nurse is often in the best position to address adher- of Pharmacotherapy, 39(7), 1198–1203.
ence. As nursing assumes an expanded role in an array of settings, 14. Christensen, A. J. (2004). Patient adherence to medical treatment regi-
the nurse often assumes responsibility for patient education, en- mens: Bridging the gap between behavioral science and bio-medicine.
Current Perspectives in Psychology. New Haven: Yale University Press.
suring that the patient understands the regimen, and for arranging 15. Granger, B. B., Moser, D., Harrell, J., et al. (2007). A practical use of the-
needed follow-up. Additionally, the voluminous body of literature ory to study adherence. Progress in Cardiovascular Nursing, 22(3), 152–158.
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on adherence, compliance, persistence and concordance verify the in- 16. Poluzzi, E., Strahinja, P., Vargiu, A., et al. (2005). Initial treatment of hy-
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creasingly greater attention being given to this important issue re- pertension and adherence to therapy in general practice in Italy. Euro-
lated to care delivery and clinical outcomes. The identification of pean Journal of Clinical Pharmacology,61(8), 603–609.
the different levels of factors that affect adherence, for example, pa- 17. Taira, D. A., Gelber, R. P., Davis, J., et al. (2007). Antihypertensive ad-
herence and drug class among Asian Pacific Americans. Ethnicity &
tient, regimen, provider, and system, also provide evidence that Health, 12(3), 265–281.
this is no longer viewed as a ‘patient problem’ but rather one that 18. USDA. (2008). Nutrient intake from food: Mean amount consumed per
each member of the health care teams needs to assume responsi- individual by race/ethnicity and age, one day, 2003–2004. Retrieved
March 2, 2008, from http://www.ars.usda.gov/ba/bhnrc/fsrg.
bility for and address. 19. CDC. (2007). Prevalence of fruit and vegetable consumption and physical
The nursing profession has shown leadership in promoting pa- activity by race/ethnicity—United States 2005. Morbidity and Mortality
tient education in past decades, and more recently in advancing Weekly Report, 56(13), 301–304.
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the case-management role. It is time again for nursing to take the 20. Ogden, C., Carroll, M., Curtin, L., et al. (2006). Prevalence of over-
lead and intervene to improve adherence. This requires looking at weight and obesity in the United States, 1999–2004. JAMA, 295(13),
1549–1555.
how health care is provided and determining where interventions 21. CDC. (2006). Summary health statistics for U.S. adults: National
need to be directed (i.e., at the level of the system, the provider, Health Interview Survey 2005. Vital Health Statistics.
the treatment regimen, or the patient). Most likely, all four com- 22. WHO. (2008). The facts about smoking and health. Retrieved March 2,
ponents of the system need to be addressed when making changes 2008, from http://www.wpro.who.int/media_centre/fact_sheets/fs_
20060530.htm.
to facilitate improved adherence. Moreover, the changes need to 23. Hughes, J. R., Keely, J., & Naud, S. (2004). Shape of the relapse curve and
be addressed over the continuum of care provision, particularly long-term abstinence among untreated smokers. Addiction, 99(1), 29–38.
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during the maintenance phase, when nonadherence is most likely 24. Aveyard, P., & West, R. (2007). Managing smoking cessation. BMJ,
to become an issue. 335(7609), 37–41.