Research digest: Identifying medication adherence challenges to support best practice across Europe

3rd January 2025

A recent study identifying critical indicators related to medication adherence emphasises the complexity of the issue and the difficulty in predicting adherence to medications. The findings suggest a need for tailored, country-specific interventions and health policies to increase adherence, improve health outcomes and reduce economic burdens.

Researchers identified and prioritised indicators related to medication adherence (IRMAs) across 39 European countries and Israel through an online expert survey. Follow-up work involved collecting country-specific data on IRMAs in two countries through a targeted literature review and subsequent data validation with a second online expert survey.

Survey participants were medication adherence experts from various clinical fields, including physicians, pharmacists, psychologists and nurses who were all part of the European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE).

A total of 17 out of 34 invited ENABLE members responded to the initial survey, resulting in 205 indicators of IRMA. The second survey saw 21 participants rank the 205 indicators, and 25 indicators emerged with a relevance score above 3.5.

The researchers were able to group the IRMAs into six main categories:

1. Country characteristics such as healthcare provider, demographics or method of payment
2. Social and economic factors including how medication was paid for and socioeconomic status
3. Therapy-related factors such as the number of medications taken
4. Patient-related factors linked to behaviours and attitudes
5. Condition-related factors around the nature of the illness
6. Healthcare system-related factors such as availability of services.

In addition, the researchers included ‘country population’ as an additional indicator because of its essential role in facilitating comparative analyses across countries in the future.

The findings offered a comprehensive understanding of the factors influencing medication adherence and successfully highlighted the priority areas as perceived by healthcare professionals engaged in this field. They will have significant implications for policymakers, healthcare providers and researchers, according to the researchers.

‘These results suggest that effective adherence-enhancing interventions must extend beyond addressing patient and therapy-related factors to include broader socio-economic and healthcare system-related determinants,’ the researchers said.

The researchers said the findings will enable fair comparisons across countries and provide a basis for the prediction of medication adherence rates in further studies.

Further research is also needed to rank these indicators accordingly and better comprehend their impact, and this could benefit from incorporating patient viewpoints to enhance the comprehensiveness and applicability of the findings, the researchers added.

Reference
Ágh T et al. and European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE) Collaborators (2024). Identifying and presenting key country-specific indicators related to medication adherence: a comprehensive study across European countries. Front. Pharmacol. 15:1390629. doi: 10.3389/fphar.2024.1390629.

Women receive unequal treatment after myocardial infarction, Scottish study finds

2nd January 2025

Women in Scotland were undertreated compared to men after a myocardial infarction, with the odds of receiving medicines that can prevent another myocardial infarction ‘stacked against you’ if you are female, researchers suggest.

The first national study in Scotland to examine the difference in treatment and outcomes between the sexes found that women are less likely to receive medicines that can prevent future myocardial infarction, strokes and cardiovascular complications.

The findings are published in the European Journal of Preventive Cardiology and build on an earlier study by the same authors, which found that following a diagnosis of heart disease, the death rate from cardiovascular causes for women increased relative to that of men.

Myocardial infarction is a leading cause of death and disability around the world, affecting men and women differently. The overall association between a person‘s sex and myocardial infarction outcomes is unclear and could be related to different treatment practices between the sexes in healthcare systems.

The researchers examined the treatment and outcome of 15,776 women and 31,287 men admitted to hospital after a myocardial infarction across Scotland between 2010 and 2016. Outcomes in the hospital were analysed according to rates of percutaneous coronary intervention, secondary prevention and mortality.

Each patient was followed for an average of eight years post-hospital discharge until the end of 2021, and rates of cardiovascular mortality and new cardiovascular events were monitored.

The researchers compared the findings to 81,341 matched healthy people without heart disease.

The study found that women were 13% less likely to undergo percutaneous coronary intervention and 6% less likely to undergo cardiac catheterisation than men whilst they were in hospital. Women were also 9% less likely to receive preventative treatments such as statins, beta-blockers or antiplatelets over the follow-up period.

Overall, female patients had lower long-term death rates in comparison to men, but the ‘female survival advantage’ – an observation in which women usually live longer than men – was less pronounced in the people with myocardial infarction.

The researchers found no significant differences in areas across Scotland, but sex differences were more pronounced in deprived areas.

Dr Tiberiu Pana, honorary early career clinical research fellow at the University of Aberdeen, who led the study, said: ‘Our results confirm the presence of important sex differences amongst Scottish heart attack patients. This important finding should guide patients and doctors to work together to improve prescription uptake and compliance with recommended preventative treatments to reduce the burden of heart disease in our population.

Dr Pana emphasised the need to improve the long-term outcomes of women after myocardial infarction, but the researchers also found that treatment for men could also be improved.

Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation and consultant cardiologist, said it was important that existing evidence-based treatments reach both men and women.

But, she added: ‘Time and time again, data show that the odds of receiving medicines that can prevent another heart attack, or a future stroke appear stacked against you if you are a woman. Solving why, including by redressing system and society biases, could help more women in Scotland and other countries live in good health for longer.’

In May 2024, a study revealed that cholesterol-lowering drugs are less frequently prescribed to women compared to men, despite European Society of Cardiology guidelines recommending statins for all patients with chronic coronary syndrome.

A version of this article was originally published by our sister publication Nursing in Practice.