A qualitative study of cardiac rehabilitation patients’ perspectives on taking medicines: implications for the ‘medicines-resistance’ model of medicine-taking

Background The appropriate use of medicines continues to be an important area of inter-disciplinary research activity both in the UK and beyond. Key qualitative work in this area in the last decade has included the ‘medicines resistance’ model of medicine-taking, which was based on a meta-ethnography of 37 qualitative studies. This model proposed that patients approach medicine-taking as ‘passive accepters’, ‘active accepters’, ‘active modifiers’ or ‘complete rejecters’, of which the latter two categories were considered to show ‘resistance’ to medicines. However, critical assessment of the model appears to be currently lacking, particularly in terms of its use in clinical practice. This paper seeks to contribute to the literature in this area by critically examining the practical application of the model in light of the findings from a qualitative, follow-up study of cardiac rehabilitation patients’ perspectives and experiences of using medicines. Methods Following ethical approval, in-depth, audiotaped, qualitative interviews were conducted with fifteen patients who had completed a UK hospital-based cardiac rehabilitation programme. Participants were aged 42–65, white British and from a variety of socioeconomic backgrounds. Interview topics included perspectives on coronary heart disease, medicine-taking and lifestyle changes. Follow-up interviews with ten patients approximately nine months later explored whether their perspectives had changed. Results The findings suggest that the active/passive and accepter/modifier distinctions may not allow for clear determination of which profile a patient fits into at any given point, and that definitions such as ‘accepter’ and ‘resistance’ may be insufficiently discerning to categorise patients’ use of medicines in practice. These problems appear to arise when the issue of patients’ accounts about medicines adherence are considered, since patients may have concerns or disquiet about medicines whether or not they are adherent and the model does not consider disquiet in isolation from adherence. Conclusions Practical application of the ‘medicines resistance’ model of medicine-taking may be problematic in this patient group. Dissociation of disquiet about medicines from medicines adherence may allow for a focus on helping patients to resolve their disquiet, if possible, without this necessarily having to be viewed in terms of its potential effect on adherence

Identification of barriers that impede the implementation of nicotine replacement therapy in the acute cardiac care setting

BackgroundNicotine replacement therapy (NRT) has been shown to increase 12-month abstinence rates by as much as 50% when compared with placebo; however, NRT seems to be underutilized in the acute cardiac setting. This study explores the attitudes and beliefs of healthcare professionals regarding the use of NRT in acute cardiac inpatients, in an effort to identify and expose barriers that may impede the use of this drug in the acute cardiac care environment.MethodFramework analysis formed the methodological foundation of the study and provided the structure for analysis of data generated via qualitative, semistructured one-on-one interviews. A purposive sample of healthcare professionals practicing in the acute cardiac care setting informed the study.ResultsAlthough health care professionals expressed strong views regarding the benefits of implementing NRT as a smoking cessation intervention, barriers were identified that hinder its use. Financial implications, lack of knowledge and safety issues all contributed to the institutional justification for rejecting hospital-based NRT as a secondary prevention intervention in the acute cardiac setting.ConclusionTo proactively reduce the incidence of secondary cardiac events, education of healthcare professionals concerning tobacco addiction and available cessation treatments in the acute cardiac patient is paramount. Nicotine replacement products require further investigation to ascertain their safety and financial viability in the acute cardiac setting. Findings may support the implementation of NRT in the inpatient cardiac setting, and ultimately help curb the incidence of smoking-related mortality owing to secondary cardiac events.Fiona C. May, Nigel Stocks, Christopher Barto

Perceived stress as a predictor of the self-reported new diagnosis of symptomatic CHD in older women

This article describes one aspect of a prospective cohort study of 10,432 women aged between 70 and 75 years. After a 3-year period, 503 women self-reported a new diagnosis by a doctor of angina or myocardial infarction (symptomatic coronary heart disease [CHD]). Time one psychosocial variables (Duke Social Support Index, time pressure, Perceived Stress Scale, Mental Health Index, having a partner, educational attainment, and location of residence) were analyzed using univariate binary logistic regression for their ability to predict subsequent symptomatic CHD. Of these variables, the Duke Social Support Index, Perceived Stress Scale and the Mental Health Index were found to be significant predictors of symptomatic CHID diagnosis. Only the Perceived Stress Scale, however, proved to be a significant independent predictor. After controlling for time one nonpsychosocial variables, as well as the frequency of family doctor visits, perceived stress remained a significant predictor of the new diagnosis of symptomatic CHD in this cohort of older women over a 3-year period