Abstract
BackgroundAdherence to recommendations and medication is deemed to be important for effectiveness of case management interventions. Thus, reasons for non-adherence and effects on health-related quality of life (HRQoL) should be fully understood. The objective of this research was to identify determinants of non-adherence to medication and recommendations, and to test whether increased adherence improved HRQoL in patients after myocardial infarction (MI) in a case management intervention.MethodsData were obtained from the intervention group of the KORINNA study, a randomized controlled trail of a nurse-led case management intervention with targeted recommendations in the elderly after MI in Germany. Reasons for non-adherence were described. Logistic mixed effects models and OLS (ordinary least squares) were used to analyze the effect of recommendations on the probability of adherence and the association between adherence and HRQoL.ResultsOne hundred and twenty-seven patients with 965 contacts were included. Frequent reasons for non-adherence to medication and recommendations were “forgotten” (22%; 11%), “reluctant” (18%; 18%), “side effects” (38%; 7%), “the problem disappeared” (6%; 13%), and “barriers” (0%; 13%). The probability of adherence was lowest for disease and self-management (38%) and highest for visits to the doctor (61%). Only if patients diverging from prescribed medication because of side effects were also considered as adherent, 3-year medication adherence was associated with a significant gain of 0.34 quality-adjusted life years (QALYs).ConclusionsMost important determinants of non-adherence to medication were side effects, and to recommendations reluctance. Recommended improvements in disease and self-management were least likely adhered. Medication adherence was associated with HRQoL.Trial registrationCurrent Controlled Trials ISRCTN02893746, retrospectively registered, date assigned 27/03/2009.
Highlights
Adherence to recommendations and medication is deemed to be important for effectiveness of case management interventions
It has been shown that patients with Coronary heart disease (CHD) who have suffered a myocardial infarction (MI) experienced significantly decreased health-related quality of life (HRQoL) compared with both, CHD patients without infarction and the general population, as measured by generic instruments such as EQ-5D-3 L and visual analog scale (VAS) [2, 3]
Improving adherence to medication and healthy lifestyle is deemed to be important in heart diseases, especially after MI, because continuous therapy improves several clinical outcomes which are associated with improved HRQoL [7]
Summary
Adherence to recommendations and medication is deemed to be important for effectiveness of case management interventions. Reasons for non-adherence and effects on health-related quality of life (HRQoL) should be fully understood. The objective of this research was to identify determinants of non-adherence to medication and recommendations, and to test whether increased adherence improved HRQoL in patients after myocardial infarction (MI) in a case management intervention. Adherence to other aspects of therapy, such as healthy lifestyle, disease management and reduced personal risk factors are important for effective therapy [5]. Improving adherence to medication and healthy lifestyle is deemed to be important in heart diseases, especially after MI, because continuous therapy improves several clinical outcomes which are associated with improved HRQoL [7].
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