Patients’ and health professionals’ attitudes and perceptions towards the initiation of preventive drugs for primary prevention of cardiovascular disease: a systematic review of qualitative studies

Abstract

BackgroundStatins and antihypertensive agents are recommended for primary prevention of cardiovascular disease (CVD), but they are not always prescribed to eligible patients.Design & settingA systematic review of qualitative studies.AimTo explore health professionals’ and patients’ attitudes towards cardiovascular preventive drugs.MethodMEDLINE, Embase, PsychINFO, CINAHL, ASSIA, HMIC, Conference Proceedings Citation Index, and Open Grey were searched for studies of qualitative design without restrictions on date or language. Two reviewers performed study selection, data extraction, quality assessment, and thematic synthesis.ResultsIn total, 2585 titles and abstracts were screened, yielding 27 studies, of which five met eligibility criteria on full text assessment. These included 62 patients and 47 health professionals. Five themes emerged about patient attitudes: questioning preventive drugs; perceived benefit and risks, such as improving quality of life; patient preferences; trust in health professional judgement; and family, friends, and media influences. Five themes emerged about health professional attitudes: addressing patient concerns and information; duty as a health professional to prescribe; uncertainty about preventive drug prescribing; recognising consequences of prescribing, such as unnecessary medicalisation; and personalised treatment.ConclusionThe attitudes of patients and health professionals regarding drug initiation for primary prevention reflect the complexity of the patient–health professional encounter in primary practice. For prescribing to be more adherent to guidelines, research should further investigate the patient–health professional relationship and the appropriate communication methods required when discussing drug initiation, specifically for primary prevention.

What is the quantity, quality and type of systematic review evidence available to inform the optimal prescribing of statins and antihypertensives? A systematic umbrella review and evidence and gap map

“…Medications of interest within the 80 reviews included in our umbrella review were: statins (n=10),25–34 antihypertensives (n=38),35–72 and statins and antihypertensives (n=34) 73–104. Nine of the reviews synthesised qualitative evidence,27 31 42 50 55 58 60 61 83 104 four of which also included quantitative evidence in a mixed evidence synthesis 42 50 58 61.…”

“…Medications of interest within the 80 reviews included in our umbrella review were: statins (n=10),25–34 antihypertensives (n=38),35–72 and statins and antihypertensives (n=34) 73–104. Nine of the reviews synthesised qualitative evidence,27 31 42 50 55 58 60 61 83 104 four of which also included quantitative evidence in a mixed evidence synthesis 42 50 58 61. Of the reviews synthesising quantitative evidence evaluating interventions, interventions focused on: enhancing patient adherence to medication as prescribed (n=57),25 30 32–35 37–41 43–46 48 49 51 53 54 56 57 59 62 63 65–71 73–81 86 87 89–96 98–103 105 deprescribing a prescribed medication (n=6)36 46 72 80 88 93 or optimising the prescribing of medication to meet the needs of the patient (n=13) 26 28 29 38 52 64 71 84 85 87 90 100 106.…”

“…Five reviews synthesised qualitative research 27 31 50 55 104. One high-quality review of qualitative evidence explored patient and family members views of the barriers and enablers to treatment adherence for heterozygous familial hypercholesterolaemia 27.…”

“…Two of these reviews included a range of different perspectives,31 50 while the other focused on patient perspectives 55. One ‘critically low’ quality review explored practitioner and patient views of prescribing or adhering to statin and/or antihypertensive medication 104…”

“… 55 One ‘critically low’ quality review explored practitioner and patient views of prescribing or adhering to statin and/or antihypertensive medication. 104 …”