Improving long-term adherence to statin therapy: a qualitative study of GPs’ experiences in primary care

Krüger, Karen; Leppkes, Niklas; Gehrke-Beck, Sabine; Herrmann, Wolfram; Algharably, Engi Abd El-Hady; Kreutz, Reinhold; Heintze, Christoph; Filler, Iris

doi:10.3399/bjgp18x696173

Cited by 18 publications

(22 citation statements)

References 35 publications

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“…Our findings regarding GPs' perspective on reasons for not prescribing recommended medication in older patients correspond with qualitative findings for statins [23,36] and post-MI prescribing in the elderly [31]. However, in contrast to a focus group study from the Netherlands, our study has not revealed barriers relating to organisation, such as the finding that many patients had fallen into the gap between secondary and primary care and were no longer visiting their specialist [31].…”

Section: Comparison With Existing Literaturesupporting

confidence: 72%

“…This is in contrast to a study which has shown that adherence after MI is insufficient [33] and underlines that their adherence assessment is limited. That physicians assess non-adherence by checking prescription refill records [36], by asking the patients [44,45] and by monitoring lipid values [36] has also been reported in previous studies. Furthermore, GPs' view that adherence depends on patients' experiences during MI is in accordance with findings from interviews with patients after MI [46].…”

Section: Comparison With Existing Literaturementioning

confidence: 57%

“…Knowledge of possible reasons for non-adherence enables physicians to recognise individual barriers to adherence [34,35]. However, few studies have reported the ways in which physicians assess adherence to secondary preventive medication [36]. In addition, to our knowledge, physicians' perceptions of reasons for non-adherence after acute coronary syndrome have only been studied for Clopidogrel in the USA and the perceived main reason were the costs for the patients [37].…”

Section: Introductionmentioning

confidence: 99%

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Prescribing and medical non-adherence after myocardial infarction: qualitative interviews with general practitioners in Germany

2020

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Background: An increasing prevalence of having survived a myocardial infarction increases the importance of medical secondary prevention. Although preventive medication reduces mortality, prescribing and adherence are known to be frequently insufficient. General practitioners are the most important prescriber. However, their perspective on prescribing and medical non-adherence following myocardial infarction has not yet been explored. Thus, the aim of this study was to explore the general practitioners' perspective on long-term care after myocardial infarction focussing on medical prevention. Methods: In this qualitative interview study we conducted episodic interviews with sixteen general practitioners from rural and urban surgeries in Germany. Framework analysis with focus on general practitioners' prescribing and patients' non-adherence was performed. Results: Almost all general practitioners reported following guidelines for myocardial infarction aftercare and prescribing the medication that was initiated in the hospital; however, they described deviating from guidelines because of drugs' side effects or patients' intolerances. Some questioned the benefits of medical secondary prevention for the oldest of patients. General practitioners perceived good adherence among their patients who had had an MI while they regarded their methods for assessing medical non-adherence as limited. They perceived diverse reasons for non-adherence, particularly side effects, patients' freedom from symptoms and patients' indifference to health. They attributed mainly negative characteristics, like lack of knowledge and understanding, to non-adherent patients. These characteristics contribute to the difficulty of convincing these patients to take medications as prescribed. General practitioners improved adherence by preventing side effects, explaining the medication's necessity, facilitating intake and involving patients in decision-making. However, about half of the general practitioners reported threatening their patients with negative consequences of non-adherence.

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Section: Comparison With Existing Literaturesupporting

confidence: 72%

Section: Comparison With Existing Literaturementioning

confidence: 57%

Section: Introductionmentioning

confidence: 99%

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Prescribing and medical non-adherence after myocardial infarction: qualitative interviews with general practitioners in Germany

2020

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“…8 9 Adverse events are rare but nevertheless pose barriers for statin treatment both in patients and physicians. [10][11][12] Current European and Swedish guidelines recommend a treatment goal for LDL-C below 1.8 mmol/L in patients with established CHD. 13 14 There has been a gradual improvement in the proportion of patients in Sweden reaching the LDL-C target 1 year after an acute myocardial infarction (AMI), and recent data suggests a figure of 65% in 2017.…”

Section: Introductionmentioning

confidence: 99%

Adherence to lipid-lowering guidelines for secondary prevention and potential reduction in CVD events in Swedish primary care: a cross-sectional study

et al. 2020

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ObjectivesThe protective effect of lipid-lowering treatment for secondary prevention after coronary heart disease (CHD) has been well documented. Current guidelines recommend a target level for low-density lipoprotein cholesterol (LDL-C) of ≤1.8 mmol/L. The aim was to describe lipid-lowering treatment patterns and to provide an estimate of the potential reductions in cardiovascular disease (CVD) events with improved adherence to guidelines.DesignCross-sectional.SettingPrimary care in a large Swedish region.Participants37 120 patients with CHD in a Swedish regional primary care quality register (QregPV), by 31 December 2015.Primary and secondary outcome measuresProportion of patients on statin treatment and proportion of patients achieving LDL-C ≤1.8 mmol/L. Estimated number of CVD events calculated for (1) current treatment, (2) improved treatment and (3) lowered LDL-C, based on applying rate reductions from meta-analyses of randomised trials to the potentially undertreated population. Risk estimation modelling was based on 52 042 patients in the same register on January 2011 followed for 5 years.ResultsOf 37 120 patients, 18% reached LDL-C ≤1.8 mmol/L and 32% were not on statin treatment. Based on individual risks, the estimated number of CVD events in the study group over 5 years was 9209/37 120. If all patients without a statin or with less potent statin treatment were given atorvastatin 80 mg, an estimated reduction of CVD events by 14% (7901 vs 9209) was seen. If all patients achieved LDL-C ≤1.8 mmol/L, the number of events was estimated to be reduced by 18% (7577 vs 9209).ConclusionOne-third of patients with CHD in primary care were not on lipid-lowering treatment. Based on the assumption that included patients would react to statin therapy the same way as the patients in randomised trials, improved adherence to treatment guidelines could lead to a substantial reduction in new CVD events.

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“…Definition of nocebo (nocebos, plural). All panelists agreed to include this topic, and all agreed to the recommended definition 4…”

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confidence: 99%

European Headache Federation recommendations for placebo and nocebo terminology

et al. 2020

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Background and aim Despite recent publications, practitioners remain unfamiliar with the current terminology related to the placebo and nocebo phenomena observed in clinical trials and practice, nor with the factors that modulate them. To cover the gap, the European Headache Federation appointed a panel of experts to clarify the terms associated with the use of placebo in clinical trials. Methods The working group identified relevant questions and agreed upon recommendations. Because no data were required to answer the questions, the GRADE approach was not applicable, and thus only expert opinion was provided according to an amended Delphi method. The initial 12 topics for discussion were revised in the opinion of the majority of the panelists, and after a total of 6 rounds of negotiations, the final agreement is presented. Results/recommendations Two primary and mechanism-based recommendations are provided for the results of clinical trials: [1] to distinguish the placebo or nocebo response from the placebo or nocebo effect; and [2] for any favorable outcome observed after placebo administration, the term “placebo response” should be used, and for any unfavorable outcome recorded after placebo administration, the term “nocebo response” should be used (12 out of 17 panelists agreed, 70.6% agreement). The placebo or nocebo responses are attributed to a set of factors including those that are related to the medical condition (e.g. natural history, random comorbidities, etc.), along with idiosyncratic ones, in which the placebo or nocebo effects are attributed to idiosyncratic, or nonspecific mechanisms, exclusively (e.g. expectation, conditioning, observational learning etc.). To help investigators and practitioners, the panel summarized a list of environmental factors and idiosyncratic dynamics modulating placebo and nocebo effects. Some of them are modifiable, and investigators or physicians need to know about them in order to modify these factors appropriately to improve treatment. One secondary recommendation addresses the use of the terms “placebo” and “nocebo” (“placebos” and “nocebos” in plural), which refer to the triggers of the placebo/nocebo effects or responses, respectively, and which are inert agents or interventions that should not be confused with the placebo/nocebo responses or effects themselves (all panelists agreed, 100% agreement). Conclusion The working group recommends distinguishing the term response from effect to describe health changes from before to after placebo application and to distinguish the terms placebo(s) or nocebo(s) from the health consequences that they cause (placebo/nocebo responses or effects).

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Improving long-term adherence to statin therapy: a qualitative study of GPs’ experiences in primary care

Cited by 18 publications

References 35 publications

Prescribing and medical non-adherence after myocardial infarction: qualitative interviews with general practitioners in Germany

Prescribing and medical non-adherence after myocardial infarction: qualitative interviews with general practitioners in Germany

Adherence to lipid-lowering guidelines for secondary prevention and potential reduction in CVD events in Swedish primary care: a cross-sectional study

European Headache Federation recommendations for placebo and nocebo terminology

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