Doctoral Defence in Biomedical Sciences – Ingibjörg Gunnþórsdóttir

On Friday, 18 September, Ingibjörg Gunnþórsdóttir, clinical pharmacist, will defend her doctoral thesis in Biomedical Sciences at the University of Iceland’s Faculty of Medicine. The thesis is entitled:

Medication Adherence in Heart Failure: Translating Healthcare Provider and Patient Perspectives into Clinical Practice.

The opponents are Dr Liset van Dijk, Professor at Nivel, Netherlands Institute for Health Services Research, the Netherlands, and Dr Lisa Anderson, Professor at St George’s University of London.

Professor Karl K. Andersen was the principal supervisor, and Inga Jóna Ingimarsdóttir, Assistant Professor, was the co-supervisor. Other members of the doctoral committee were Erla Svansdóttir, psychologist; Martin Ingi Sigurðsson, Professor; and Anna Ingibjörg Gunnarsdóttir, clinical pharmacist.

Professor Sædís Sævarsdóttir, Dean of the Faculty of Medicine, will preside over the ceremony, which will take place in the Ceremonial Hall of the University of Iceland (Hátíðasalur) and begin at 9:00 a.m.

Abstract

Medication adherence (MA) in heart failure (HF) is essential to effective treatment, yet it is inconsistently assessed in clinical practice and no validated HF-specific MA assessment tool is currently available.

This thesis examined MA in HF across three phases, integrating perspectives from cardiac healthcare providers (HCPs), patients, and an expert panel to develop a clinical framework and inform an HF-specific patient-reported assessment tool.
Phase I comprised a cross-sectional survey among 73 cardiac HCPs at Landspítali – University Hospital. The patient–provider relationship, suitable drug formulations, healthcare support at home, and multidose dispensing from pharmacies were considered important. Alcohol or substance misuse, limited understanding of medication benefits, and cognitive impairment were among the main barriers. Although 73% agreed that MA should be routinely assessed and documented, fewer than half reported doing so consistently.

Phase II was a qualitative study combining four focus groups and 12 in-depth interviews with 27 patients with HF. Four interdependent themes emerged: (1) practical aspects, (2) psychosocial influences, (3) healthcare-related factors, and (4) disease- and medication-related factors. Stable routines facilitated adherence, whereas midday doses, diuretic burden, asymptomatic periods, emotional distress, and fragmented care were key challenges. Hospitalisation and symptom worsening often served as turning points that reinforced the necessity of treatment. Most patients reported never having been directly asked about their medications during clinical follow-up.

Phase III was a structured expert panel consensus process using the RAND/UCLA Appropriateness Method, involving a multidisciplinary panel of 15 experts. Findings from the previous phases informed the development of 73 candidate items, evaluated across four sections. Agreement was reached on 34 clinical framework items addressing identification of patients at risk of suboptimal adherence, adherence-supportive care, and structured MA assessment in clinical practice. Agreement was also reached on 31 patient-reported items forming the basis for the development of an HF-specific MA assessment tool.

About the Doctoral Candidate

Ingibjörg Gunnþórsdóttir was born in Reykjavík in 1974. She graduated with a degree in Pharmacy from the University of Iceland in 2004. Following her graduation, she worked briefly at Lyf og heilsa before joining Landspítali University Hospital the same year, where she worked in the Clinical Pharmacy Services Division of the Hospital Pharmacy and received training in clinical pharmacy.

Ingibjörg has since worked in clinical pharmacy services across numerous departments at Landspítali and has participated in the development of clinical services, educational materials and clinical guidelines. In 2013, she joined the Department of Cardiology at Landspítali, and since 2015 she has also worked as a consulting clinical pharmacist at the hospital’s Heart Failure Outpatient Clinic.

Alongside her clinical work, Ingibjörg has taught and supervised students at the University of Iceland, including pharmacy students, postgraduate pharmacy trainees and nurses undertaking postgraduate studies. She has also supervised research and final-year projects. In recent years, her research has focused primarily on pharmacotherapy and medication adherence among patients with heart failure. She began her doctoral studies at the University of Iceland in 2020.

Ingibjörg’s mother is Jónína Þorbjörnsdóttir, a developmental therapist, and her stepfather is Hjalti Magnússon, an auditor. Her biological father is Gunnþór Ingason, a priest. Her husband is Ármann Agnarsson, a graphic designer, and their sons are Breki I. Ýmisson, Hjalti Sveinn Viktorsson, Sturla Ármannsson and Dagur Ármannsson.