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Published in: BMC Cardiovascular Disorders 1/2017

Open Access 01-12-2017 | Research article

Exploring the impact of financial barriers on secondary prevention of heart disease

Authors: Kirnvir K. Dhaliwal, Kathryn King-Shier, Braden J. Manns, Brenda R. Hemmelgarn, James A. Stone, David J. T. Campbell

Published in: BMC Cardiovascular Disorders | Issue 1/2017

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Abstract

Background

Patients with coronary artery disease experience various barriers which impact their ability to optimally manage their condition. Financial barriers may result in cost related non-adherence to medical therapies and recommendations, impacting patient health outcomes. Patient experiences regarding financial barriers remain poorly understood. Therefore, we used qualitative methods to explore the experience of financial barriers to care among patients with heart disease.

Methods

We conducted a qualitative descriptive study of participants in Alberta, Canada with heart disease (n = 13) who perceived financial barriers to care. We collected data using semi-structured face-to-face or telephone interviews inquiring about patients experience of financial barriers and the strategies used to cope with such barriers. Multiple analysts performed inductive thematic analysis and findings were bolstered by member checking.

Results

The aspects of care to which participants perceived financial barriers included access to: medications, cardiac rehabilitation and exercise, psychological support, transportation and parking. Some participants demonstrated the ability to successfully self-advocate in order to effectively navigate within the healthcare and social service systems.

Conclusion

Financial barriers impacted patients’ ability to self-manage their cardiovascular disease. Financial barriers contributed to non-adherence to essential medical therapies and health recommendations, which may lead to adverse patient outcomes. Given that it is such a key skill, enhancing patients’ self-advocacy and navigation skills may assist in improving patient health outcomes.
Literature
2.
go back to reference Morrison LJ, Verbeek R, McDonald AC, et al. Mortality and prehospital thrombolysis for acute myocardial infarction: A meta-analysis. JAMA. 2000;283:2686–92.CrossRefPubMed Morrison LJ, Verbeek R, McDonald AC, et al. Mortality and prehospital thrombolysis for acute myocardial infarction: A meta-analysis. JAMA. 2000;283:2686–92.CrossRefPubMed
3.
go back to reference Prasad A, Rihal CS, Lennon RJ, et al. Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: A 25-year experience from the mayo clinic. JACC. 2007;49:1611–8.CrossRefPubMed Prasad A, Rihal CS, Lennon RJ, et al. Trends in outcomes after percutaneous coronary intervention for chronic total occlusions: A 25-year experience from the mayo clinic. JACC. 2007;49:1611–8.CrossRefPubMed
4.
go back to reference Hanley GE. Prescription drug insurance and unmet need for healthcare: A cross-sectional analysis. Open Med. 2009;3:178–83. Hanley GE. Prescription drug insurance and unmet need for healthcare: A cross-sectional analysis. Open Med. 2009;3:178–83.
5.
go back to reference Roterman M, Sanmartin C, Hennessy D, et al. Prescription medication use by Canadians aged 6 to 79. Stat Can Health Rep. 2014;25:03–9. Roterman M, Sanmartin C, Hennessy D, et al. Prescription medication use by Canadians aged 6 to 79. Stat Can Health Rep. 2014;25:03–9.
6.
go back to reference Martin BJ, Hauer T, Arena R, et al. Cardiac rehabilitation attendance and outcomes in coronary artery disease patients. Circulation. 2012;126:677–87.CrossRefPubMed Martin BJ, Hauer T, Arena R, et al. Cardiac rehabilitation attendance and outcomes in coronary artery disease patients. Circulation. 2012;126:677–87.CrossRefPubMed
7.
go back to reference Jolly SE, Navaneethan SD, Schold JD, et al. Development of a chronic kidney disease patient navigator program. BMC Nephrol. 2015;16:01–8.CrossRef Jolly SE, Navaneethan SD, Schold JD, et al. Development of a chronic kidney disease patient navigator program. BMC Nephrol. 2015;16:01–8.CrossRef
8.
go back to reference Ronksley PE, Sanmartin C, Campbell DJT, et al. Perceived barriers to primary care among western Canadians with chronic conditions. Stat Can Health Rep. 2014;25:03–10. Ronksley PE, Sanmartin C, Campbell DJT, et al. Perceived barriers to primary care among western Canadians with chronic conditions. Stat Can Health Rep. 2014;25:03–10.
9.
go back to reference Chen J, Feng H. Unmet needs for healthcare. Stat Can Health Rep. 2002;13:23–34. Chen J, Feng H. Unmet needs for healthcare. Stat Can Health Rep. 2002;13:23–34.
10.
go back to reference Kelly E, Ivers N, Zawi R, et al. Patient navigators for people with chronic disease: protocol for a systematic review and meta-analysis. Syst Rev. 2015;4:01–6.CrossRef Kelly E, Ivers N, Zawi R, et al. Patient navigators for people with chronic disease: protocol for a systematic review and meta-analysis. Syst Rev. 2015;4:01–6.CrossRef
11.
go back to reference Campbell DJT, King-Shier K, Hemmelgarn BR, et al. Self-reported financial barriers to care among patients with cardiovascular related chronic conditions. Stat Can Health Rep. 2014;25:03–12. Campbell DJT, King-Shier K, Hemmelgarn BR, et al. Self-reported financial barriers to care among patients with cardiovascular related chronic conditions. Stat Can Health Rep. 2014;25:03–12.
12.
go back to reference Rahimi AR, Spertus JA, Reid KJ, et al. Financial barriers to health care and outcomes after acute myocardial infarction. JAMA. 2007;297:1063–72.CrossRefPubMed Rahimi AR, Spertus JA, Reid KJ, et al. Financial barriers to health care and outcomes after acute myocardial infarction. JAMA. 2007;297:1063–72.CrossRefPubMed
14.
go back to reference Kennedy J, Morgan S. Cost-related prescription nonadherence in the United States and Canada: A system-level comparison using the 2007 international health policy survey in seven countries. Clin Ther. 2009;31:213–9.CrossRefPubMed Kennedy J, Morgan S. Cost-related prescription nonadherence in the United States and Canada: A system-level comparison using the 2007 international health policy survey in seven countries. Clin Ther. 2009;31:213–9.CrossRefPubMed
16.
go back to reference Campbell DJT, Ronksley PE, Manns BJ, et al. The association of income with health behavior change and disease monitoring among patients with chronic disease. PLoS One. 2014;9(4):e94007.CrossRefPubMedPubMedCentral Campbell DJT, Ronksley PE, Manns BJ, et al. The association of income with health behavior change and disease monitoring among patients with chronic disease. PLoS One. 2014;9(4):e94007.CrossRefPubMedPubMedCentral
18.
go back to reference Hennessy D, Sanmartin C, Ronksley P, et al. Out-of-pocket spending on drugs and pharmaceutical products and cost-related prescription non-adherence among Canadians with chronic disease. Stat Can Health Rep. 2016;27:03–8. Hennessy D, Sanmartin C, Ronksley P, et al. Out-of-pocket spending on drugs and pharmaceutical products and cost-related prescription non-adherence among Canadians with chronic disease. Stat Can Health Rep. 2016;27:03–8.
19.
go back to reference Richards H, Reid M, Watt G. Victim-blaming revisited: A qualitative study of beliefs about illness causation, and responses to chest pain. Fam Pract. 2003;20:711–6.CrossRefPubMed Richards H, Reid M, Watt G. Victim-blaming revisited: A qualitative study of beliefs about illness causation, and responses to chest pain. Fam Pract. 2003;20:711–6.CrossRefPubMed
20.
go back to reference Campbell DJT, Manns BJ, Hemmelgarn BR, et al. The Development of a Conceptual Framework for Understanding Financial Barriers to Care for Patients with Cardiovascular-Related Chronic Disease: A Protocol for a Grounded Theory (Qualitative) Study. CMAJ Open. 2016;2:E304–8.CrossRef Campbell DJT, Manns BJ, Hemmelgarn BR, et al. The Development of a Conceptual Framework for Understanding Financial Barriers to Care for Patients with Cardiovascular-Related Chronic Disease: A Protocol for a Grounded Theory (Qualitative) Study. CMAJ Open. 2016;2:E304–8.CrossRef
21.
go back to reference Campbell DJT, Manns BJ, Leblanc P, et al. Finding resiliency in the face of financial barriers: Development of a conceptual framework for people with cardiovascular-related chronic disease. Medicine. 2016;95:1–8.CrossRef Campbell DJT, Manns BJ, Leblanc P, et al. Finding resiliency in the face of financial barriers: Development of a conceptual framework for people with cardiovascular-related chronic disease. Medicine. 2016;95:1–8.CrossRef
22.
go back to reference Curry LA, Nembhard IM, Bradley EH. Qualitative and mixed methods provide unique contributions to outcomes research. Circulation. 2009;119:1442–52.CrossRefPubMed Curry LA, Nembhard IM, Bradley EH. Qualitative and mixed methods provide unique contributions to outcomes research. Circulation. 2009;119:1442–52.CrossRefPubMed
23.
go back to reference Krumholz HM, Bradley EH, Curry LA. Promoting publication of rigorous qualitative research. Circ Cardiovasc Qual Outcomes. 2013;6:133–4.CrossRefPubMed Krumholz HM, Bradley EH, Curry LA. Promoting publication of rigorous qualitative research. Circ Cardiovasc Qual Outcomes. 2013;6:133–4.CrossRefPubMed
24.
go back to reference Sandelowski M. Focus on Qualitative Methods: Sample Size in Qualitative Research. Res Nurs Health. 1995;18:179–83.CrossRefPubMed Sandelowski M. Focus on Qualitative Methods: Sample Size in Qualitative Research. Res Nurs Health. 1995;18:179–83.CrossRefPubMed
25.
go back to reference Musselwhite K, Cuff L, McGregor L, King KM. The telephone interview is an effective method of data collection in clinical nursing research: a discussion paper. Int J Nurs Stud. 2007;44:1064–70.CrossRefPubMed Musselwhite K, Cuff L, McGregor L, King KM. The telephone interview is an effective method of data collection in clinical nursing research: a discussion paper. Int J Nurs Stud. 2007;44:1064–70.CrossRefPubMed
26.
go back to reference Charmaz K. Constructing Grounded Theory. Los Angeles: Sage; 2014. Charmaz K. Constructing Grounded Theory. Los Angeles: Sage; 2014.
27.
go back to reference Strauss A, Corbin J. Basics of Qualitative Research. Thousand Oaks: SAGE Publications; 1998. Strauss A, Corbin J. Basics of Qualitative Research. Thousand Oaks: SAGE Publications; 1998.
28.
go back to reference Sandelowski M. Rigor or rigor mortis: the problem of rigor in qualitative research revisited. Adv Nurs Sci. 1993;16:1–8.CrossRef Sandelowski M. Rigor or rigor mortis: the problem of rigor in qualitative research revisited. Adv Nurs Sci. 1993;16:1–8.CrossRef
30.
go back to reference Campbell DJT, Manns BJ, Weaver RG, et al. Financial barriers and adverse clinical outcomes among patients with cardiovascular-related chronic diseases: A cohort study. In Press. BMC Medicine; 2017. Campbell DJT, Manns BJ, Weaver RG, et al. Financial barriers and adverse clinical outcomes among patients with cardiovascular-related chronic diseases: A cohort study. In Press. BMC Medicine; 2017.
31.
go back to reference Ho PM, Magid DJ, Shetterly SM, et al. Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease. Am Heart J. 2008;155:772–9.CrossRefPubMed Ho PM, Magid DJ, Shetterly SM, et al. Medication nonadherence is associated with a broad range of adverse outcomes in patients with coronary artery disease. Am Heart J. 2008;155:772–9.CrossRefPubMed
32.
go back to reference Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: Its importance in cardiovascular outcomes. Circulation. 2009;119:3028–35.CrossRefPubMed Ho PM, Bryson CL, Rumsfeld JS. Medication adherence: Its importance in cardiovascular outcomes. Circulation. 2009;119:3028–35.CrossRefPubMed
33.
go back to reference Campbell DJT, Soril LJJ, Clement F. Impact of cost-sharing mechanisms on patient-borne medication costs. JAMA Intern Med. 2016;176:1703–4.CrossRefPubMed Campbell DJT, Soril LJJ, Clement F. Impact of cost-sharing mechanisms on patient-borne medication costs. JAMA Intern Med. 2016;176:1703–4.CrossRefPubMed
34.
go back to reference Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: Associations with medication and medical utilization and spending and health. JAMA. 2007;298:61–9.CrossRefPubMed Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: Associations with medication and medical utilization and spending and health. JAMA. 2007;298:61–9.CrossRefPubMed
36.
go back to reference Campkin LM, Boyd JM, Campbell DJT. Coronary artery disease patient perspectives on exercise participation. Journal of Cardiopulmonary Rehabilitation and Prevention 2016; epub ahead of print. Campkin LM, Boyd JM, Campbell DJT. Coronary artery disease patient perspectives on exercise participation. Journal of Cardiopulmonary Rehabilitation and Prevention 2016; epub ahead of print.
37.
go back to reference Clark AM, King-Shier KM, Thompson DR, et al. A qualitative systematic review of influences on attendance at cardiac rehabilitation programs after referral. Am Heart J. 2012;164:835–45. e2.CrossRefPubMed Clark AM, King-Shier KM, Thompson DR, et al. A qualitative systematic review of influences on attendance at cardiac rehabilitation programs after referral. Am Heart J. 2012;164:835–45. e2.CrossRefPubMed
38.
go back to reference Balady GJ, Ades PA, Bittner VA, et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond. Circulation. 2011;124:2951–60.CrossRefPubMed Balady GJ, Ades PA, Bittner VA, et al. Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond. Circulation. 2011;124:2951–60.CrossRefPubMed
39.
go back to reference Nielsen KM, Faergeman O, Foldspang A, Larsen ML. Cardiac rehabilitation: Health characteristics and socio-economic status among those who do not attend. Eur J Public Health. 2008;18:479–83.CrossRefPubMed Nielsen KM, Faergeman O, Foldspang A, Larsen ML. Cardiac rehabilitation: Health characteristics and socio-economic status among those who do not attend. Eur J Public Health. 2008;18:479–83.CrossRefPubMed
40.
41.
go back to reference Arthur HM. Depression, isolation, social Support, and cardiovascular disease in older adults. J Cardiovasc Nurs. 2006;21:S2–7.CrossRefPubMed Arthur HM. Depression, isolation, social Support, and cardiovascular disease in older adults. J Cardiovasc Nurs. 2006;21:S2–7.CrossRefPubMed
42.
go back to reference Wiltshire J, Cronin K, Sarto GE, Brown R. Self-Advocacy during the medical encounter: Use of health information and racial/ethnic differences. Med Care. 2006;44:100–9.CrossRefPubMed Wiltshire J, Cronin K, Sarto GE, Brown R. Self-Advocacy during the medical encounter: Use of health information and racial/ethnic differences. Med Care. 2006;44:100–9.CrossRefPubMed
44.
go back to reference Manderson B, Mcmurray J, Piraino E, et al. Navigation roles support chronically ill older adults through healthcare transitions: a systematic review of the literature. Health Soc Care Community. 2012;20:113–27.CrossRefPubMed Manderson B, Mcmurray J, Piraino E, et al. Navigation roles support chronically ill older adults through healthcare transitions: a systematic review of the literature. Health Soc Care Community. 2012;20:113–27.CrossRefPubMed
45.
46.
47.
go back to reference Reinier K, Thomas E, Andrusiek DL, et al. and the Resuscitation, Outcomes Consortium Investigators. Socioeconomic status and incidence of sudden, cardiac arrest. CMAJ. 2011;183:1705–12.CrossRefPubMedPubMedCentral Reinier K, Thomas E, Andrusiek DL, et al. and the Resuscitation, Outcomes Consortium Investigators. Socioeconomic status and incidence of sudden, cardiac arrest. CMAJ. 2011;183:1705–12.CrossRefPubMedPubMedCentral
Metadata
Title
Exploring the impact of financial barriers on secondary prevention of heart disease
Authors
Kirnvir K. Dhaliwal
Kathryn King-Shier
Braden J. Manns
Brenda R. Hemmelgarn
James A. Stone
David J. T. Campbell
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Cardiovascular Disorders / Issue 1/2017
Electronic ISSN: 1471-2261
DOI
https://doi.org/10.1186/s12872-017-0495-4

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