Abstract 129: Patients’ Perspectives of Participating in an Intervention to Improve Medication Adherence after ACS hospitalization A Qualitative Analysis

Objective: Few studies have documented the patient’s perspective on interventions designed to change health behavior. Patients choose to participate in studies and to execute prescribed behaviors. Understanding patients’ choices and the reasoning behind their choices may help to explain variation in intervention effectiveness. Our objective was to understand patients’ perspectives of participating in a study designed to improve medication adherence after acute coronary syndrome (ACS) hospitalization comprised of automated medication refill reminders and educational messages, and pharmacist support. Methods: Sixty six in-depth interviews were conducted with patients in a study of an intervention to improve medication adherence after ACS hospitalization. Transcripts of interviews were analyzed using a grounded theory approach and content analysis. Results: Some patients reported that having an ACS event redefined their identities based on real and perceived physical limitations. Bi-directional relationships between patients and providers were a key factor of medication adherence. Patients comfortable being honest with their providers are active participants in the shared decision making process that is inherent for adherence. Patients expressed that providers need to be open to their divergent opinions. Some patients explained that clinicians don’t have the time to hear all the details the patient needed to share. Other patients felt their providers just did not listen to them. Positive attitudes towards medications and life in general strengthened adherence to recommended treatments. Some reported fear of having another event and of dying, and that this fear affected their behaviors, while others reported that fear hindered change. In addition, having the support of people to remind, organize and encourage patients helped adherence. Routines and pill boxes were identified as effective aids. Most patients did not remember receiving the automated messages. Conclusions: Among patients participating in a multifaceted study to improve medication adherence, bi-directional and open conversations with providers positively influenced adherence behavior. Fear of another ACS event, having social support and utilizing adherence aides were also influential factors. Future interventions designed to improve medication adherence should incorporate these patient-identified factors.