Understanding Coronary Artery Disease

Introduction

Coronary Artery Disease (CAD) is the most common heart disease experienced worldwide. According to the National Institute of Heart (NIH), CAD is the leading cause of deaths in the Southern Australia for both male and female people ("Coronary Artery Disease | CAD | MedlinePlus", 2019). This disease is caused when the arteries supplying blood to the heart (Coronary Artery) become hard and narrow. This hardness and narrowness are caused by deposition of materials like cholesterol and plaque in the inner walls of the arteries. This build-up is known as atherosclerosis. As the arteries become narrow, less blood flows through them. As a result, heart muscles receive less blood than they require for a normal functioning. This means that there is a limited supply of oxygen to the heart. This condition can lead to a heart attack. A heart attack is experienced when a blood clot cuts off the supply of blood to the heart causing permanent damage to the heart. CAD can also cause weakening of the heart muscles leading to a condition known as heart failure and arrhythmias. Heart failure refers to a condition where the heart is unable to pump the blood well to all parts of the body. Arrhythmias means that the normal rhythm of the body is altered; hence, blood cannot flow normally.

Background

Having known that CAD is a multifactorial disease, researchers have come up with a global approach towards mitigating the risk factors to reduce coronary events. This approach does not entirely rely on pharmacological therapy but also essential non-pharmacological aspects of the treatment procedure. The therapy provided to the patients after an event of cardiac arrest involves lifestyle changing measures and drug intake (Wiesche, 2017). The drugs include platelet anti-aggregation agents, angiotensin-converting enzyme inhibitors, and better-blockers. This treatment is aimed at reducing the occurrence of coronary events. Adherence to the treatment process requires the commitment of a multidisciplinary team that offers guidance to the patient. Lack of such guidance could make it hard to assess the success of the expected treatment for any particular patient or a given group. The process of adherence is complex and influenced by factors such as the environment of the patient, availability of health professionals, and the medical and nursing care provided to the patient. Lack of adherence makes it difficult to achieve therapeutic objectives and leads to frustration among the professionals involved in the process. Research indicates that, among other factors, awareness of patients about their disease is key to the process of adherence. Other factors such as awareness of physio pathological mechanisms, triggering factors, risks, treatment benefits also contribute to better adherence. The multidisciplinary team is vital in providing guidance o nonpharmacological therapeutic measures. This advice contributes to a better understanding of the disease by the patients, their ability to assess signs and symptoms, promotion of healthy habits among patients, lifestyle change, and use of drugs and their effects, and encouragement of patients in participating in self-care programs. The world norms and disease management require that the nurses and the multidisciplinary team be keen on their performance as it is vital in promotion and protection as well as recovery from diseases. They also assist individuals in remaining healthy, promoting self-care and, therefore, improving their quality of life. This research is aimed at identifying factors that affect the adherence of CAD patients cared for by the multi-disciplinary team to pharmacological and non-pharmacological therapies.

Problem Statement

The National Institute of Health (NIH) has reported that coronary artery disease is the leading cause of death in the Southern Australia. This has led to the introduction of a global approach that could help reduce cases of coronary events. The approach focuses both on pharmacological and non-pharmacological treatment procedures. There has been, however, variation in the adherence to the treatment across various study groups. This variation in adherence to the treatment has resulted in a difference in the ability of various groups to achieve the goals of the treatment process. This research is aimed at identifying the factors that affect the adherence of patients to the treatment procedure that is aimed at controlling coronary heart disease.

Definition of Terms

1. Medical Adherence:

This refers to the degree to which a patient correctly follows the advice offered to them by a medical profession? The patients are supposed to comply with the medication as advised by the doctor.

2. Multidisciplinary Patient Care Team

This refers to a group consisting of healthcare professionals such as physicians, registered nurses, physician assistants, clinical pharmacists, and other healthcare professionals. They must ensure that they provide high quality coordinated care to patients.

Research questions

Since this research is aimed at determining the perceptions around the adherence of coronary patients to treatment procedures, below are the research questions the study is expected to answer:

1. What are the perceptions of patients towards CHD and adherence to treatment procedures?

2. What are the perceptions of nurses towards CHD and adherence to treatment procedures?

3. What analytical conclusions can be drawn from these findings?

4. How can these conclusions inform policy formulation regarding adherence to CHD medication?

Research Purpose

The global approaches of dealing with coronary heart disease are expected to work effectively if the procedure is well adhered to. There are cases where the approach has failed to meet the expectations due to a lack of adherence to the treatment procedure. In this regard, the purpose of this study is to explore the perceptions of adherence to medication by patients with CHD and nurses working in this area.

Research Aims

The following aims form the basis of conducting this study:

1. To interview CHD patients about adherence to medication

2. To interview nurses caring for CHD patients about medication

3. To analyse the perceptions of nurses about CHD

4. To analyse the perceptions of patients about CHD

5. To draw analytical conclusions about the concept of adherence to CHD medication

6. To formulate policies and structures that will help in ensuring CHD patients adhere to medication

Theoretical Framework

Participant interviews will be used to collect data about adherence to medication, which is a complex health behavior displayed by patients in a variety of ways. This will be related to the various theories that explain this behavior and provide insight into how medical professionals can predict the influencing factors. The interviews will also provide the basis for explaining the impact of socio-economic factors such as age and gender that are described as weak predictors of adherence. Similarly, supplementary factors, such as the perception of illness and personal beliefs about health, on the other hand that are perceived to be strong predictors will also be accounted for through participant interviews. The impact of non-adherence to medication will be deduced through patient observation. Non-adherence can be viewed as intentional or unintentional. Intentional non-adherence is based on perceptual barriers of patients. In such a case, the patient can adhere but makes a conscious decision not to adhere. This decision is determined by factors such as illness perception and the perception of the patient on health. Unintentional non-adherence is when the patient is willing to adhere to medication but cannot adhere. There are physical barriers to adherence, such as dexterity or memory problems that prevent the patient from taking their medication.

LITERATURE REVIEW.

World Health Organization's Report of Adherence to Medication

According to the World Health Organization, non-adherence is a worldwide problem with data showing that between 30 to 50 percent of patients prescribed medicines for long term conditions do not take medicines as prescribed (Costa et al, 2015). This rate of non-adherence has resulted in conditions such as sub-optimal treatment outcomes, increased mortality rates, wasted healthcare resources, and high rate of hospital re-admission (Easthall & Barnett, 2017). Most interventions to adherence lack progress in the field. Those that have recorded some positive results have shown marginal gains, and positive impacts are rare. Researchers claim that lack of grounding of intervention theories as one of the factors contributing to this failure. They also claim that the initiators ail to target the intervention towards the specific determinants of adherence.

Problems with Therapeutic Non-adherence

There are various implications to non-compliance, both clinical and non-clinical, that need assessment. From healthcare providers, there are two main impacts of non-adherence. First of all, non-adherence could lead to serious clinical issues and has a direct impact on treatment outcomes. The patients who fail to comply with treatment procedure to coronary issues are among the highest to report poor treatment outcomes. Some of the impacts that have been identified to associate with lack of compliance to the treatment procedure in patients with coronary artery disease include poorly controlled blood pressure, risk of stroke, myocardial infarction, and renal impairment. Data from the National Health and Nutrition Examination Survey, a body that provides periodic health information about the US population, indicates that only 31 percent of coronary patients in the US were able to control pressure. This data was collected between 1999 and 2003 (Inder et al, 2016). There is a possibility that non-compliance to treatment procedure could have contributed to this lack of control in blood pressure (Kassahum et al, 2016). There was also a report indicating that most of the patients who failed to comply with treatment procedures dropped out of the treatments completely; therefore, did not benefit from the treatment provided.

METHODOLOGY

Design

This research will utilize constructive, grounded theory. This design is based on data collection on the experience and perception of the patients affected with Coronary conditions. There are various strategies that can be utilized in this study and various propositions constructed to enable effectiveness in compliance by coronary artery disease patients to treatments offered. Grounded theory is selected as the perfect methodology for this study as it well provides the discovery and analysis of study data by the requirements. Most social science studies are based on analysis of the data collected and conclusions drawn from the analyzed information. The identification of the crucial codes and the concepts could also be essential in the study.

Sampling

During sampling of the study population, patients who have been dragonized with chronic heart disease and have been hospitalized in the Southern Australia will be considered. The patients will be included based on the analysis of their Coronary Heart Disease (CHD) condition and the angiography conducted to determine their legibility. Exclusion of patients will be based on cognitive impairment as a result of their genetic factors. They will be interviewed, and the results recorded alongside other observations being made during the study. Other factors, such as gender and age will also be considered during the study. The education level of the patients is also crucial as it could play a part in determining their adherence to medication. The maximum period considered for the participants who are affected by coronary heart condition is 20 years. The participants will also be subdivided based on their professions and current occupations as the basis of grounded theory. Their marital status will be considered as single, married, divorced, and widowed.

Data Collection

Data collection and analysis in this study will consider all the ethical standards as set by the bodies regulating medical data collection. The participants will be required a consent allowing the study team to use their data in this study. Data collection and analysis will be simultaneous (Alvesson & Sköldberg, 2009; Charmaz & Keller, 2016; Glaser, B. & Strauss, 2006; Denzin, N. & Lincoln, 2003; May, 2002; Silverman, 2007; Silverman, 2016; Wiesche et al., 2017). Participants will be interviewed by a specific research team for a maximum of 120 minutes. Nurses and other health professionals will be required to assist the study team in making observations on patients being interviewed. The question asked will be based on generic topics aimed at collecting health information. The interviewers should be well versed with the kind of data that they expect to collect from the participants from questioning. How the observations are being made, and the data collected by observation is also crucial in this study (Silverman, 2015; Ruppel & Mey, 2015; Grbich, 2009; May 2002; Denzin& Lincoln, 2003). The interviewers should also consider comfort levels of questions that they are asking the participants. The participants will reveal vital information if they are made comfortable and the privacy of their information guaranteed. Questions will be formulated, keeping in mind the ethical code of conduct.

Data Analysis

The questions and observations are made in a way that will make it easy to analyze the information gathered. The data collected from interview questions will be categorized to enable answering of the research questions easily with enough evidence. It is important to consider the credibility of the qualitative study by ensuring that the questions that are being asked are linked to the purpose of the study. (Alvesson & Sköldberg, 2009; Charmaz & Keller, 2016; Glaser, B. & Strauss, 2006; Denzin, N. & Lincoln, 2003; May, 2002; Silverman, 2007; Silverman, 2016; Wiesche et al., 2017). Considerations of different accounts are also taken into consideration. The number of patients who conform to the prescription and coronary heart disease therapy will be examined against their ability to show success in the treatment. Data Analysis will also consider the number of patients who conform to the provided prescriptions but failed to show a success. They will then probe to identify the reasons why they failed to show positive signs after the intervention. The number of patients who failed to adhere to the medical intervention will also be considered. The reasons why they failed to adhere to the intervention will be identified. The conditions of the patients who adhered to the intervention will be compared to the conditions of those who did not, and conclusions be made.

Significance of the Study

This study will be of great significance in clinical health because it will provide an evidential explanation of the factors that affect the adherence of the CAD patients to interventional therapy. The care providers will use the results of this study to formulate strategies that will ensure that they facilitate patient adherence to interventional treatment. With the implementation of strategies, the general health of CHD victims is expected to improve.

Objectives of the Study

To determine the level of compliance of CAD patients to medical intervention procedures.

To establish factors that determine their adherence to the intervention procedures.

To identify the effects of non-compliance of the patients to the intervention measures put in place.

To come up with policies and structures that will help in ensuring that the coronary patients adhere to the intervention in place to speed up their recovery.

Strengths of the Study

There are many constraints in research, including time and resource constraints. These constraints are in place to ensure that research is completed in a given period with available resources. This study focuses more on the subtleties of what can be found and less on the metrics of data collected. This allows the researchers to gain a detailed insight into the available information being examined. This research provides dynamism in the process of study, whereby it can easily adapt to the quality of information being gathered. That means that if the available information fails to provide any results, the researchers can easily switch to gathering data in a new direction. This offers researchers an opportunity to gather data on a given subject rather than being confined to given data that does not offer results.

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Weaknesses of the Study

Data gathering in this research is very subjective where one researcher may feel that it is important to focus on gathering given data and another researcher may think it is pointless to spent time on focusing on the data. This may lead to generalized data that may be inaccurate because data collection relies on the instincts of the researcher. Since the data collected is based on individual perspective, it is difficult to prove that the data has a form of rigidity. The minds have an innate way of looking at things and, therefore, remember things the way they want to.

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