title: Perspectives of patients on factors relating to adherence to post-acute coronary syndrome medical regimens.
abstract: OBJECTIVE
  Poor adherence to cardioprotective medications after acute coronary syndrome (ACS) hospitalization is associated with increased risk of rehospitalization and mortality. Clinical trials of multifaceted interventions have improved medication adherence with varying results. Patients' perspectives on interventions could help researchers interpret inconsistent outcomes. Identifying factors that patients believe would improve adherence might inform the design of future interventions and make them more parsimonious and sustainable. The objective of this study was to obtain patients' perspectives on adherence to medical regimens after experiencing an ACS event and their participation in a medication adherence randomized control trial following their hospitalization.
  
  
  METHODS
  Sixty-four in-depth interviews were conducted with ACS patients who participated in an efficacious, multifaceted, medication adherence randomized control trial. Interview transcripts were analyzed using the constant comparative approach.
  
  
  RESULTS
  Participants described their post-ACS event experiences and how they affected their adherence behaviors. Patients reported that adherence decisions were facilitated by mutually respectful and collaborative provider-patient treatment planning. Frequent interactions with providers and medication refill reminder calls supported improved adherence. Additional facilitators included having social support, adherence routines, and positive attitudes toward an ACS event. The majority of patients expressed that being active participants in health care decision-making contributed to their health.
  
  
  CONCLUSIONS
  Our findings demonstrate that respectful collaborative communication can contribute to medication adherence after ACS hospitalization. These results suggest a potential role for training health-care providers, including pharmacists, social workers, registered nurses, etc, to elicit and acknowledge the patients' views regarding medication treatment in order to improve adherence. Future research is needed with providers to understand how they elicit and acknowledge patients' views, particularly in the face of nonadherence, and with patients to understand how to empower them to share their opinions with their providers.
authors.affiliation: Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA ; School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Lambert-Kerzner
authors.affiliation: School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA ; Cardiology, Denver Health Medical Center, Denver, CO, USA.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
authors.affiliation: Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA ; School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Plomondon
authors.affiliation: Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Fagan
authors.affiliation: Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA.
authors.forename: Marina S
authors.initials: MS
authors.lastname: McCreight
authors.affiliation: Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA.
authors.forename: Kelty B
authors.initials: KB
authors.lastname: Fehling
authors.affiliation: School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Williams
authors.affiliation: Health Services Research, Veterans Health Administration (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors.forename: Alison B
authors.initials: AB
authors.lastname: Hamilton
authors.affiliation: School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Albright
authors.affiliation: School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Blatchford
authors.affiliation: Internal Medicine, John L. McClellan Memorial Veterans Hospital, Little Rock, AR, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Mihalko-Corbitt
authors.affiliation: Health Services Research, Veterans Health Administration (VA) Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: Chris L
authors.initials: CL
authors.lastname: Bryson
authors.affiliation: Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC, USA.
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.affiliation: Health Services Research, Durham Veterans Affairs Medical Center, Durham, NC, USA.
authors.forename: Miriam A
authors.initials: MA
authors.lastname: Kirshner
authors.affiliation: Internal Medicine, John L. McClellan Memorial Veterans Hospital, Little Rock, AR, USA.
authors.forename: Eric J Del
authors.initials: EJ
authors.lastname: Giacco
authors.affiliation: Department of Crdiology, Veterans Health Administration (VA) Eastern Colorado Health Care System, Denver, CO, USA ; School of Public Health or School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
keywords: cardiovascular disease; compliance; medications; qualitative analysis