First pill hardest to swallow: An evaluation study of cardiovascular nurse-led follow-up phone calls

Helen Gräs Højgaard; Kirsten Frederiksen; Annette Langager Høgh; Marie Dahl

doi:10.1016/j.jvn.2023.11.007

First pill hardest to swallow: An evaluation study of cardiovascular nurse-led follow-up phone calls

J Vasc Nurs. 2024 Mar;42(1):35-43. doi: 10.1016/j.jvn.2023.11.007. Epub 2023 Dec 20.

Authors

Helen Gräs Højgaard¹, Kirsten Frederiksen², Annette Langager Høgh³, Marie Dahl⁴

Affiliations

¹ Vascular Research Unit, Viborg Regional Hospital, Toldbodgade 12, 6th floor, 8800, Viborg Denmark; Faculty of Health, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark. Electronic address: heleho@rm.dk.
² Department of Public Health, Aarhus University, Bartholins Allé 2, 3rd floor, 8000, Aarhus C, Denmark.
³ Vascular Research Unit, Viborg Regional Hospital, Toldbodgade 12, 6th floor, 8800, Viborg Denmark; Faculty of Health, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark.
⁴ Vascular Research Unit, Viborg Regional Hospital, Toldbodgade 12, 6th floor, 8800, Viborg Denmark; Faculty of Health, Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus, Denmark; Cardiac, Thoracic and Vascular Research Unit, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.

PMID: 38555176
DOI: 10.1016/j.jvn.2023.11.007

Abstract

Introduction: Screening for cardiovascular disease (CVD) followed by preventive medication is expected to reduce CVD (2,3,5). However, insufficient medication adherence may affect screening effectiveness (11-12). It remains uncertain which interventions are suitable to support citizens in their decision-making about taking CVD preventive medication.

Objective: We evaluated if and how three nurse-led telephone follow-up (TFU) calls supported citizens in making informed decisions regarding CVD preventive medication and thereby potentially strengthened their medication adherence.

Methods: Employing a theory-based evaluation design inspired by Dahler-Larsen (39-41), we developed and tested a programme theory describing if and how the TFU calls supported medical decision-making and potentially improved medication adherence. Data were collected via telephone.

Findings: We analysed 61 TFU calls collected between May 2017 and April 2019 and found that TFU calls supported participants' reflections on preventive medication. TFU calls supported informed decision-making regarding initiating medication, allowing participants to consider personal preferences and values, including both opting for and abstaining from medication. The content of the TFU calls revolved around four crucial themes: I) understanding the purpose of taking the medicine; II) meaningfulness and joint reflection support the decision; III) relation to healthcare professionals; and IV) taking medication for the first time.

Conclusion: TFU calls effectively supported citizens' understanding and addressed their needs. Trusted healthcare professionals' recommendations were preferred for decisional support. Initiating CVD preventive medication was particularly challenging for citizens who had not previously taken such medication. We recommend scheduling TFU calls early: the first after one week, the second after one month and the third after six months.

Keywords: Cardiovascular diseases; Communications skills; Early interventions; Evaluation research; Health screening; Medication adherence; Nurse-led telephone follow-up (TFU) calls; Nursing interventions; Prevention, Medical decision making; Qualitative research.

MeSH terms

Cardiovascular Diseases* / drug therapy
Cardiovascular Diseases* / prevention & control
Follow-Up Studies
Humans
Medication Adherence
Nurse's Role*
Telephone