Association of Primary Care Providers’ Beliefs of Statins for Primary Prevention and Statin Prescription

Abstract

Background The 2013 American College of Cardiology/American Heart Association Cholesterol Treatment Guideline increased the number of primary prevention patients eligible for statin therapy, yet uptake of these guidelines has been modest. Little is known of how primary care provider ( PCP ) beliefs influence statin prescription. Methods and Results We surveyed 164 PCP s from a community‐based North Carolina network in 2017 about statin therapy. We evaluated statin initiation among the PCP s’ statin‐eligible patients between 2014 and 2015 without a previous prescription. Seventy‐two PCP s (43.9%) completed the survey. The median estimate of the relative risk reduction for high‐intensity statins was 45% (interquartile range, 25%–50%). A minority of providers (27.8%) believed statins caused diabetes mellitus, and only 16.7% reported always/very often discussing this with patients. Most PCPs (97.2%) believed that statins cause myopathy, and 72.3% reported always/very often discussing this with patients. Most (77.7%) reported always/very often using the 10‐year atherosclerotic cardiovascular disease risk calculator, although many reported that in most cases other risk factors or patient preferences influenced prescribing (59.8% and 43.1%, respectively). Of 6172 statin‐eligible patients, 22.3% received a prescription for a moderate‐ or high‐intensity statin at follow‐up. Providers reporting greater reliance on risk factors beyond atherosclerotic cardiovascular disease risk were less likely to prescribe statins. Conclusions Although beliefs and approaches to statin discussions vary among community PCP s, new prescription rates are low and minimally associated with those beliefs. These results highlight the complexity of increasing statin prescriptions for primary prevention and suggest that strategies to facilitate standardized discussions and to address external influences on patient beliefs warrant future study.

Barriers, facilitators, and solutions to familial hypercholesterolemia treatment

“…Our study provides a multilevel contextualized view of the barriers and facilitators to treatment of FH experienced by patients and clinician stakeholders. While previous reports have identified barriers and facilitators [8][9][10][11][12][13][14], we utilized a two-step process of interviews followed by focus groups, to learn from these barriers and facilitators what solutions might work for these individuals in their context to improve relevance and generalizability to other healthcare settings. We found that both patient and clinician stakeholders proposed solutions to educate themselves and others about FH and recognized the need for increased visibility and awareness (patients) and champions (clinician stakeholder) to help increase understanding of FH in general.…”

“…The reasons for insufficient use of statin therapy are multifactorial and multilevel, ranging from underprescribing (at the clinician-level) to medication nonadherence (at the patientlevel). Patient and clinician stakeholder barriers and facilitators for hypercholesterolemia management across this continuum have been previously described [8][9][10][11][12][13][14]. General practitioners identified barriers for statin prescribing including concerns about out-of-pocket costs for patients, clinician workload (e.g., brief office visits and high patient complexity), patient refusal of treatment, and contradicting clinical practice guidelines [12].…”

Patient-Reported Reasons for Not Using Primary Prevention Statin Therapy

“…Moreover, because rates of provider trust were high, provider-based improvements in communication may yield substantial improvements in statin use rates. Prior studies show that multilevel strategies targeting physician prescribing patterns and beliefs about the safety of statin therapy may also be beneficial [ 20 ].…”

Impact of cardiologist intervention on guideline-directed use of statin therapy

“…Several other studies have reported similar trends in 2013 ACC/AHA guideline implementation, however, very little is known about the barriers to adherence. Clough et al[ 12 ] found that although community-based physicians often accurately estimated risk, beliefs and approach to statin discussion varied and these variables had minimal impact on low rates of statin prescribing. An inter-professional approach using the patient-centered medical home model made no difference in guideline implementation within a primary care practice[ 12 ].…”

“…Clough et al[ 12 ] found that although community-based physicians often accurately estimated risk, beliefs and approach to statin discussion varied and these variables had minimal impact on low rates of statin prescribing. An inter-professional approach using the patient-centered medical home model made no difference in guideline implementation within a primary care practice[ 12 ]. It has been well established that it may take up to 17 years for evidence to be fully implemented into practice, which may explain the low statin use in the overall study cohort[ 13 ].…”