Unmet expectations of medications and care providers among patients with heart failure assessed to be poorly adherent: Results from the Chronic Heart Failure Intervention to Improve MEdication Adherence (CHIME) study

Inger Ekman, Axel Wolf, Victoria Vaughan Dickson, Hayden B. Bosworth, Bradi B. Granger

Research output: Contribution to journalArticle

Abstract

Background: Ineffective medication management contributes to repeated hospitalisation and death among patients with heart failure. The meaning ascribed to medications and the influence of meaning on how patients manage medications is unknown. The purpose of this study was to explore the meaning and expectations associated with medication use in high-risk, non-adherent patients with heart failure. Methods and results: Patients (n=265) with heart failure were screened for adherence to prescribed medication using the Morisky medication adherence scale (MMAS). Patients (MMAS score <6; n=44) participated in semistructured interviews, analysed using qualitative content analysis. Of 17 initial themes (223 representative segments), the overarching theme 'unmet expectations' consisted of two subthemes 'working to be heard' by professionals and 'resignation' to both the illness and medications. Patients' expectations were challenged by unexpected work to communicate with providers in general (72 representative segments), and specifically regarding medications (118 representative segments) and feelings of resignation regarding the medication regimen (33 representative segments). Conclusions: These findings suggest that unmet expectations contribute to poor medication management. Improved listening and communication by providers, to establish a common understanding and plan for managing medications may strengthen patient beliefs, resolve feelings of resignation and improve patients' ability to manage medications effectively.

Original languageEnglish (US)
Pages (from-to)646-654
Number of pages9
JournalEuropean Journal of Cardiovascular Nursing
Volume16
Issue number7
DOIs
StatePublished - Oct 1 2017

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Medication Adherence
Heart Failure
Emotions
Aptitude
Hospitalization
Communication
Interviews

Keywords

  • Adherence
  • patient-provider communication
  • patient-reported
  • person-centered medication management
  • qualitative research
  • self-management

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medical–Surgical
  • Advanced and Specialized Nursing

Cite this

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title = "Unmet expectations of medications and care providers among patients with heart failure assessed to be poorly adherent: Results from the Chronic Heart Failure Intervention to Improve MEdication Adherence (CHIME) study",
abstract = "Background: Ineffective medication management contributes to repeated hospitalisation and death among patients with heart failure. The meaning ascribed to medications and the influence of meaning on how patients manage medications is unknown. The purpose of this study was to explore the meaning and expectations associated with medication use in high-risk, non-adherent patients with heart failure. Methods and results: Patients (n=265) with heart failure were screened for adherence to prescribed medication using the Morisky medication adherence scale (MMAS). Patients (MMAS score <6; n=44) participated in semistructured interviews, analysed using qualitative content analysis. Of 17 initial themes (223 representative segments), the overarching theme 'unmet expectations' consisted of two subthemes 'working to be heard' by professionals and 'resignation' to both the illness and medications. Patients' expectations were challenged by unexpected work to communicate with providers in general (72 representative segments), and specifically regarding medications (118 representative segments) and feelings of resignation regarding the medication regimen (33 representative segments). Conclusions: These findings suggest that unmet expectations contribute to poor medication management. Improved listening and communication by providers, to establish a common understanding and plan for managing medications may strengthen patient beliefs, resolve feelings of resignation and improve patients' ability to manage medications effectively.",
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