Patients’ and Providers’ Perspectives of a Polypill Strategy to Improve Cardiovascular Prevention in Australian Primary Health Care

Abstract

Background-This study explores health provider and patient attitudes toward the use of a cardiovascular polypill as a health service strategy to improve cardiovascular prevention. Methods and Results-In-depth, semistructured interviews (n=94) were conducted with health providers and patients from Australian general practice, Aboriginal community-controlled and government-run Indigenous Health Services participating in a pragmatic randomized controlled trial evaluating a polypill-based strategy for high-risk primary and secondary cardiovascular disease prevention. Interview topics included polypill strategy acceptability, factors affecting adherence, and trial implementation. Transcribed interview data were analyzed thematically and interpretively. Polypill patients commented frequently on cost-savings, ease, and convenience of a daily-dosing pill. Most providers considered a polypill strategy to facilitate improved patient medication use. Indigenous Health Services providers and indigenous patients thought the strategy acceptable and beneficial for indigenous patients given the high disease burden. Providers noted the inflexibility of the fixed dose regimen, with dosages sometimes inappropriate for patients with complex management considerations. Future polypill formulations with varied strengths and classes of medications may overcome this barrier. Many providers suggested the polypill strategy, in its current formulations, might be more suited to high-risk primary prevention patients. Conclusions-The polypill strategy was generally acceptable to patients and providers in cardiovascular prevention.Limitations to provider acceptability of this particular polypill were revealed, as was a perception it might be more suitable for high-risk primary prevention patients, though future combinations could facilitate its use in secondary prevention. Participants suggested a polypill-based strategy as particularly appropriate for lowering the high cardiovascular burden in indigenous populations. Clinical Trial Registration-URL: http://www.anzctr.org.au. ANZCTRN: 12608000583347.(Circ Cardiovasc Qual Outcomes. 2015;8:301-308.

Stroke survivors', caregivers' and GPs' attitudes towards a polypill for the secondary prevention of stroke: a qualitative interview study

“…While a polypill was acceptable to most patients of the UMPIRE trial, some felt that FDC therapy was less tailored to individual patient needs. 49 A recent investigation of the views of cardiovascular patients and providers who participated in polypill trials reported similar advantages and concerns to those identified in our study, 50 suggesting that polypill perspectives translate to other regions and healthcare settings.…”

The role of contextualisation in enhancing non-communicable disease programmes and policy implementation to achieve health for all

“…In 2019, the PolyIran trial demonstrated that the combination of aspirin, atorvastatin, and either lisinopril or valsartan led to a 34% lower risk (95% CI 20-45%) for cardiovascular events compared with usual care over 5 years when implemented in a large, cluster-randomized trial across 236 villages (n = 6,838 participants) in Iran [10]. These results contrasted with the Kanyini-GAP polypill trial in Australia (n = 623 participants), where there were no significant differences in changes in risk factors nor clinical outcomes between groups over 18 months despite a 49% (95% CI 30-72%) higher relative rate of self-reported adherence to indicated therapy among individuals randomised to aspirin, simvastatin, lisinopril, and either atenolol or hydrochlorothiazide compared with usual care [11]. Differences in outcomes between these trials may be due to differences in the respective comparator groups, i.e.…”

Treatment of Modifiable Risk Factors Is Associated With Decrease in Coronary Heart Disease Incidence: Time to Use the Polypill

“…Regarding the costs of treatment with the polypill for primary and secondary CVD prevention, several studies have shown that the cost benefits of polypill use were significantly lower than the use of component drugs given separately. In addition, the patient and doctor acceptance of the polypill were significantly higher compared with the component drugs given separately . .…”

“…In addition, no problems have been found between the component drugs of the polypill regarding bioavailability and pharmacokinetic interactions . With respect to the effectiveness and costs of the polypill, these have been shown to be highly acceptable by patients and doctors alike . In fact, the polypill has been called “a best bargain” for the primary and secondary prevention of CVD and strokes.…”

“…17 With respect to the effectiveness and costs of the polypill, these have been shown to be highly acceptable by patients and doctors alike. [10][11][12][13][14][15][16] In fact, the polypill has been called "a best bargain" for the primary and secondary prevention of CVD and strokes. Despite these positive results, acceptance and approval of the polypill by the FDA and WHO have been resisted so far for lack of outcomes data.…”