Necessity and concerns about lipid‐lowering medical treatments and risk factors for non‐adherence: A cross‐sectional study in Palestine

Abstract

Aims Strong evidence indicates that drugs reduce blood lipids and improve cardiovascular end‐points, leading to their wide usage. However, the success of these drugs can be affected by poor patient's adherence to prescribed medication. This study aimed to evaluate medication adherence in patients with dyslipidaemia in association with patient beliefs about medicines. Methods The study was conducted from January 2019 to July 2019 at the middle governmental primary healthcare clinics in Ramallah and Bethlehem cities, and used a cross‐sectional design. Adherence was determined using the 4‐item Morisky medication adherence scale, while beliefs were determined using the Beliefs about Medicines Questionnaire. Results Of 220 patients, 185 agreed to participate in the study, resulting in a response rate of 84.1%. Of the participants, 106 (57.3%) were men, and almost half (88, 46.5%) were ≥56 years. Medication non‐adherence was high (47.6%), but a majority (65.5%) reported believing their treatment to be necessary for their continued good health. Accordingly, the mean necessity score (17.3, SD 3.7) significantly outweighed (P < .001) the mean concerns score (14.0, SD 3.5). Multivariate regression demonstrated four variables to be significantly correlated with non‐adherence: illiterate (OR = 2.52; CI: 0.9‐4.3; P = .03), polypharmacy (OR = 3.18; CI: 1.9‐5.7; P = .007), having comorbidity (OR = 3.10; CI: 2.2‐4.6; P = .005) and having concerns about side effects (OR = 2.89; CI: 1.1‐4.6, P = .04). Conclusion Non‐adherence among patients taking lipid‐lowering agents was high despite most holding positive beliefs regarding medication necessity. This may be due to concern also being high. Physicians should identify and target high‐risk patients and individualise their treatment plans in order to achieve adequate control of dyslipidaemia.

Determinants of Non-Adherence to the Medications for Dyslipidemia: A Systematic Review

“…Non-adherence was considered if statins and/or ezetimibe were stopped or dosage was decreased Increased non-adherence: peripheral artery disease, atrial fibrillation, coronary artery bypass surgery Decreased non-adherence: taking aspirin, P2Y12 inhibitors or β-blockers (at discharge from cardiovascular event) Bruckert et al (2020) 58 Retrospective observational cohort study The Pharmacoepidemiologic General Research eXtension (PGRx)-acute coronary syndrome (ACS) registry, from cardiology centres (France) 2.695 patients Adherence was measured using the Proportion of Days Covered (PDC). Patients were considered adherent if they had a PDC ≥80% Decreased non-adherence: previous cardiovascular disease event Seaman et al (2020) 59 Retrospective observational study Western Australian Population (Australia) 205.924 patients Medication possession ratio (MPR), with the threshold of adherence defined as 80% Increased non-adherence: younger age, living in more remote areas, not having previous ischemic heart disease, not having previous coronary artery revascularization procedure, not having previous statin use, beneficiary status, not taking cardiovascular medication, higher number of other medications Decreased non-adherence: older age Shakarneh et al (2020) 60 Cross-sectional study, by survey Two middle governmental primary healthcare clinics in the cities of Ramallah and Bethlehem (Palestine) 185 patients Adherence was determined using the 4-item Morisky medication adherence scale (MMAS-4). Total scores were summed (range 0–4), with scores of 0–1 denoting high adherence and 2–4 denoting low adherence Increased non-adherence: low education (illiterate), polypharmacy (> 4), comorbidities, concerns about side effects …”

“… 41 Also, in patients presenting side effects or expressing concerns about them, non-adherence is higher, 14 , 24 , 53 with an associated odds ratio of 2.89. 60 Non-adherence is also worst in patients having a higher duration of lipid-lowering treatment. 19 , 47 On the other hand, several studies have shown that non-adherence is lower in patients taking β-blockers, 55–57 who have approximately less 12% risk of non-adherence 27 , 54 as in patients taking other cardiovascular medications.…”