Patient-Reported Barriers to Adherence Among ACEI/ARB Users from a Motivational Interviewing Telephonic Intervention

Figures & data

Figure 1 Baseline adherence trajectory groups.

Table 1 Baseline Demographic of Patients Who Received the Intervention

Variable	Intervention, N=247
Age, mean (SD)	72.06 (9.28)
Sex, n (%)
Female	148 (59.92)
Male	99 (40.08)
Health plan, n (%)
Low-income subsidy	122 (49.39)
No subsidy	125 (50.61)
Prescriber specialty, n (%)
General	211 (87.92)
Specialty	29 (12.08)
Refill type, n (%)
≥90 days	219 (88.66)
<90 days	28 (11.34)
Comorbidities
Myocardial Infarction
Yes	4 (1.62)
No	243 (98.38)
End-Stage Renal Disease
Yes	3 (1.21)
No	244 (98.79)
Depression
Yes	31 (12.55)
No	216 (87.45)
Congestive Heart Failure
Yes	26 (10.53)
No	221 (89.47)
Stroke
Yes	10 (4.05)
No	237 (95.95)
Coronary Artery Disease
Yes	65 (26.32)
No	182 (73.68)
Number of Other Medications on Index Date
>2	71 (28.74)
≤2	176 (71.26)
Previous Hospitalization
≥1	27 (10.93)
None	220 (89.07)
Prevalent Users
Yes	219 (88.66)
No	28 (11.34)
Regimen Complexity, Mean (SD)	4.22 (4.28)
CMS Risk Score, Mean (SD)	1.50 (0.99)
Adherence trajectory
Rapid decline, n (%)	47 (19.03)
Gradual decline, n (%)	98 (39.68)
Gaps in adherence, n (%)	102 (41.30)

Abbreviations: CMS, The Centers for Medicare and Medicaid Services; SD, standard deviation.

Figure 2 Motivational interviewing intervention flowchart.

Table 2 Barriers to ACEI/ARB Adherence Identified from the Initial Call, in Total and Across Trajectories

Barrier	Total, n (%)	Rapid Decline, n (%)	Gaps in Adherence, n (%)	Gradual Decline, n (%)
Denial of barrier	102 (39.69)	17 (36.17)	45 (42.45)	40 (38.46)
Forgetfulness	66 (25.68)	18 (38.30)	27 (25.47)	21 (20.19)
Discontinued by physician	20 (7.78)	2 (4.26)	4 (3.77)	14 (13.46)
Side effect	16 (6.23)	1 (2.13)	9 (8.49)	6 (5.77)
Multiple Comorbidities/Polypharmacy	13 (5.06)	3 (6.38)	4 (3.77)	6 (5.77)
Lack of Knowledge About Disease/Medication	10 (3.89)	3 (6.38)	2 (1.89)	5 (4.81)
Cost issues	9 (3.50)	None	5 (4.72)	4 (3.85)
Family Issues/Affected by a disaster	7 (2.72)	1 (2.13)	2 (1.89)	4 (3.85)
Physician/Pharmacy Communication Issue	5 (1.95)	None	3 (2.83)	2 (1.92)
Transportation Barrier	4 (1.56)	1 (2.13)	1 (0.94)	2 (1.92)
Lack of organization or routine	4 (1.56)	1 (2.13)	3 (2.83)	None
Physician Adjusted Dose	1 (0.39)	None	1 (0.94)	None

Note: The percentages were calculated based on column totals.

Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker.

Table 3 New Barriers to ACEI/ARB Adherence Identified from the Follow-Up Calls

Barrier	Patients With Different Initial Barrier (N=28) n (%)	Patients With Initial Denial (N=18) n (%)
Forgetfulness	12 (38.71)	13 (65)
Lack of Knowledge About Disease/Medication	5 (16.13)	2 (10)
Family Issues/Affected by a disaster	5 (16.13)	None
Side Effect	3 (9.68)	2 (10)
Medication Cost/Affordability	3 (9.68)	None
Physician/Pharmacy Communication Issue	2 (6.45)	1 (5)
Multiple Comorbidities/Polypharmacy	1 (3.23)	None
Transportation Barrier	None	2 (10)

Note: The percentages were calculated based on column totals.

Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker.