A narrative analysis of patients’ experiences of taking medication for secondary prevention of acute myocardial infarction

Abstract

Following an acute myocardial infarction, patients are given a daily regime of five medications to prevent secondary cardiovascular events. However, adherence to these medications has been measured to be 66%1. Sub-optimal adherence leads to increased mortality, morbidity and associated healthcare system costs. There is a lack of qualitative research of this experience for these patients, and current interventions, such as Dossett trays and New Medicines Service interviews are based upon presumed difficulties, such as memory and physical medication issues. The aim of this study was to better understand patient’s experience of taking medication to prevent a further AMI, using a narrative analysis framework to describe their relationship with their medication and healthcare professionals. Following ethical approval (UREC 18/36), participants were recruited with inclusion criteria of adults taking medication following at least one previous episode of AMI. Following signed informed consent, semi-structured interviews were conducted with fifteen people from central and southern England. Interviews were conducted in person, online, or on the telephone and audio recorded. The recordings were transcribed verbatim and organised using NVivo software. A narrative analysis framework was used to organise themes within the whole of each participant’s story and then separated into narrative arcs and organised by theme2. The whole story analysis showed the differences between each participant’s story, and that each participant’s story contained varying complicating factors that were personal and specifically important to their lives. The presence of side effects was a complicating factor for most participants. The narrative arc analysis showed that initially, participants felt they began taking medication with little control, feeling compelled to follow their prescriber’s directions and ‘do what they were told’. They understood the benefit to their health, and quickly built routine into their lives. At the next stage, participants worked in collaboration with their prescriber. They had acquired knowledge and social support of non-prescribing professionals, which enabled them to recognise side effects, which they tolerated. Missed doses were viewed as insignificant, happening infrequently and balanced by a history of medication continuity. A crisis point was reached when side effects became unmanageable, where they sought help from their prescriber to change their medication. The desired stage to reach was stability, where participants continued to take medication, and found it simple, unnoticed, fitted into their life and monitored using biometric results. These participants were non-intentional non-adherers, and described how they successfully added a medication regime into their lives, the details of which could assist patients who find this process more difficult. They described personal and detailed stories, indicating that interventions to assist medication-taking are suited to individual patient work. Themes across all their narratives included the presence of side effects, for which they deferred to their prescriber as decision-maker for their treatment. Non-prescribing healthcare professionals were described as providing social support at later stages, but there is a potential for pharmacists to offer more support at the initial stage where participants felt they lacked control, using services such as the New Medicines Service. 1. Ma TT, Wong IC, Man KK, Chen Y, Crake T, Ozkor MA, Ding LQ, Wang ZX, Zhang L, Wei L. Effect of evidence-based therapy for secondary prevention of cardiovascular disease: Systematic review and meta-analysis. PLoS One. 2019;14(1):e0210988. 2. Ryan K, Bissell P, Morecroft C. Narratives about illness and medication: a neglected theme/new methodology within pharmacy practice research. Part II: medication narratives in practice. Pharmacy world & science. 2007 Aug;29:353-60.