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medication adherence, patients, prevention, risk factors



  1. Garavalia, Linda PhD
  2. Garavalia, Brian PhD
  3. Spertus, John A. MD, MPH
  4. Decker, Carole PhD, RN


Background and Research Objective: Adherence to evidence-based therapies has emerged as one of the great challenges of translating discoveries to clinical care to optimize patient outcomes. In particular, nonadherence to lifesaving medications continues to trouble health care systems. We conducted a series of studies to investigate why cardiac patients stop life-sustaining medications and to develop a tool to proactively address medication adherence issues. We could find no available preventive tools for communicating with patients about their medications in the clinical setting. In this article, we summarize the process of developing such a tool.


Subjects and Methods: We used a mixed-methods approach in a series of studies that included examining quantitative data from a large patient registry, conducting in-depth qualitative patient interviews, creating items representative of the qualitative findings, pilot testing items with heart patients, surveying an expert panel to establish content validity, and conducting in-depth interviews with health care providers to assess implementation opportunities.


Results and Conclusions: Patient interviews revealed that patients' values and beliefs, barriers to treatment, and prior medication-taking behavior were of primary importance in understanding medication discontinuance. Pilot testing, expert panel review, and an implementation feasibility evaluation resulted in an 11-item communication guide to be used in a variety of health care settings. Clinicians need an efficient way of systematically communicating with patients about heart medications to identify barriers and to initiate preventive interventions when patients report barriers or challenges to medication adherence.