Factors Associated With Medication Non-Adherence Among Ischemic Heart Disease Patients: Focus On Erectile Dysfunction As A Perceived Adverse Effect Of Cardioprotective Therapy
| dc.contributor.author | Yousif Nori, Ali | |
| dc.date.accessioned | 2017-02-27T02:06:31Z | |
| dc.date.available | 2017-02-27T02:06:31Z | |
| dc.date.issued | 2015-10 | |
| dc.description.abstract | Ischemic Heart Disease (IHD) is the most rampant among all cardiovascular diseases and it is the single largest cause of death in Malaysia and the world. Erectile dysfunction (ED) is a precursor to IHD and an important vascular risk factor. It can be organic or psychogenic and it remains under-recognised in the area of studying adherence to long-term cardioprotective therapy prescribed for stable IHD. The primary aim of this study was to quantify the likelihood of having ED symptoms perceived as adverse effect of cardiovascular medications as an independent correlate to non-adherence behaviour. A secondary aim was to investigate about the usefulness of a regimen review tool to detect non-adherence sensitively to each medication within a complex prescribed package. This cross-sectional study was designed to test factors that can be loaded under five dimensions of the World Health Organisation model of long-term medication use. Across pilot test and two phases, the study involved surveying 382 cardiac patients and reviewing of their medical files to get the clinical data. Phase-I included 173 patients with different cardiac conditions to demonstrate the validity of the regimen review tool and Phase-II involved 187 nondiabetic patients with stable IHD which comprised the main study. Parameters of medication non-adherence, ED and sexual communication between cardiology practitioners and patients were evaluated using structured instruments. In the main study phase, the mean age of the 26–65 years old sexually active sample of patients was 54.4 (±8.2). Average regimen complexity was 6.74 (2–13). Only 37 (19.8%) patients were able to list down all their prescribed medications and 73 patients (39%) had errors in taking their regimen accurately. Ninety six patients (51.3%) had poor overall adherence and 46 (24.6%) had a history of medication discontinuation without doctor’s consent. Among 90 patients (48.1%) who had skipped taking any dose within the past two weeks of the survey day, forgetfulness and medication adverse effects were the main reasons for non-adherence. Moderate to severe ED was prevalent in 39.6% of the sample. The overwhelming majority of patients has not been sexually counselled in the cardiology clinic whereas 71.7% reported being comfortable to discuss sexual issues with the cardiologists. Multivariate logistic regression analyses revealed four independent correlates to poor adherence and to intentional non-adherence commonly. Those were wrong regimen intake, reporting therapy-related barriers and adverse effects (such as ED), and use of anti-impotence drugs. Use of diuretics was a predictor for ED diagnosis. These findings reveal a high prevalence of ED among IHD patients but with a negligence of its treatment in the cardiology practice. ED may undermine secondary preventive therapy use and may trigger irrational use of anti-impotence drugs among patients. Reviewing the regimen by pharmacists will help identifying patients who have underlying concerns which are not easily being revealed such as sexual dysfunction. Assessment of medication adherence should encompass multidimensional factors to cover the variation of predicting intentional non-adherence to complex treatment. | en_US |
| dc.identifier.uri | http://hdl.handle.net/123456789/3781 | |
| dc.language.iso | en | en_US |
| dc.publisher | Universiti Sains Malaysia | en_US |
| dc.subject | Ischemic Heart Disease | en_US |
| dc.subject | effect of cardiovascular medications. | en_US |
| dc.title | Factors Associated With Medication Non-Adherence Among Ischemic Heart Disease Patients: Focus On Erectile Dysfunction As A Perceived Adverse Effect Of Cardioprotective Therapy | en_US |
| dc.type | Thesis | en_US |
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