Psychological Distress and Medication Adherence
Creating Order Out of Chaos?
In the current issue of Circulation Cardiovascular Quality and Outcomes, Zullig et al1 report an association between perceived life chaos and medication nonadherence among patients who had a history of acute myocardial infarction and hypertension within the previous 3 years. Patients were enrolled in the ongoing Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE) trial. SPRITE is a 3-arm randomized trial evaluating the effects of a nurse-delivered, telephone-based patient education intervention versus a web-based patient education intervention versus usual care on systolic blood pressure and other cardiovascular risk factors.2
Article see p 619
The investigators conducted a cross-sectional study of baseline data from 406 patients enrolled in the SPRITE trial. They administered a 6-item version of the Confusion, Hubbub, and Order Scale (CHAOS), which includes the following items3: (1) My life is organized. (2) My life is unstable. (3) My routine is the same from week to week. (4) My daily activities from week to week are unpredictable. (5) Keeping a schedule is difficult for me. (6) I do not like to make appointments too far in advance because I do not know what might come up. Items were rated on a 5-point Likert scale (from definitely true to definitely false), and total scores ranged from 0 to 30, with higher scores indicating greater perceived chaos. Patients also completed a Likert scale variation of the original …