Patient Satisfaction and Medication Noncompliance following Percutaneous Coronary Intervention in Armenia

Abstract

Background: Coronary heart disease (CHD) is a major cause of morbidity and mortality throughout the world. One of the expected treatments for CHD is percutaneous coronary intervention (PCI), particularly drug-eluting stent (DES) placement. Dual antiplatelet therapy consisting of aspirin and a thienopyridine drug should be given for at least a full year for patients without major risk for bleeding. Inability of the patient to comply with the recommended therapy for DES can impact reaching therapeutic goals, often leading to a deterioration of health status. Increased risk of stent thrombosis, higher incidence of death, reinfarction, or rehospitalization are associated with medication noncompliane. Low patient satisfaction from the care received and poor health status complex the problem forming a vicious cycle with medication noncompliance. Objective: The project evaluated the relationship between noncompliance with antiplathelet therapy (Aspirin, Clopidogrel (Plavix)), patient satisfaction, health status and medication affordability/cost in Nork-Marash Medical Center (NMMC) following DES placement. Methods: The analytical cross-sectional telephone survey drew on a study population that consisted of a simple random sample of 375 patients aged 18 and over, who had undergone DES placement surgery at NMMC from 2006 to 2008. Among the survey items were the Morisky Adherence Scale Score (MAS), used to measure compliance (adherence) to medications, and the Short-Form Patient Satisfaction Questionnaire (PSQ-18), used to measure satisfaction with interpersonal manner, communication and general satisfaction. Results: Mean age of the participants was 59±10 years (n=271). Most (88%) were male. The proportion of noncompliant patients was 31.0% (n=84). Only 8.1% (22 patients) reported “fair” or “poor” health status. Among the participants, 77.5% were generally satisfied with their care, 95.9% were satisfied with their caregivers’ interpersonal manner, and 88.2% were satisfied with communication with their caregivers. Virtually all (97.8%) were satisfied with discharge instructions. In bivariate logistic regression analyses, age, gender, health status, smoking status and cost were associated with medication compliance (p<0.05). Compliance was not associated with satisfaction. Multiple regression analysis revealed an association between medication compliance and cost (OR=2.57, 95% CI=1.33-4.97), “very good”/ “excellent” health status (OR=2.17, 95% CI=1.18-4.01), and age (OR=1.06, 95% CI=1.03-1.09). Conclusion: Consistent with the literature, health status, and age emerged as independent predictors of medication compliance. Patients often cited out-of-pocket costs as a contributing factor to noncompliance. Clinicians need to recognize and appropriately address these factors in following-up their patients. Further research is needed to account for time since stent placement and determining the impact of medication noncompliance on health outcomes. In addition to following the treatment guidelines, physicians should continually reinforce lifestyle advice for secondary prevention of heart attacks (e.g., smoking cessation, controlling high blood pressure).