1
|
Frieden P, Gagnon R, Bénard É, Cossette B, Bergeron F, Talbot D, Guertin JR. Strategies aiming to improve statin therapy adherence in older adults: a systematic review. BMC Geriatr 2024; 24:444. [PMID: 38773394 PMCID: PMC11110402 DOI: 10.1186/s12877-024-05031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/30/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Randomized clinical trials have shown that, under optimal conditions, statins reduce the risk of cardiovascular events in older adults. Given the prevalence and consequences of suboptimal adherence to statin among older adults, it is essential to document strategies designed to increase statin adherence in this population. The objective of this systematic review is to describe and summarize the effectiveness of interventions to improve statin adherence in older adults (≥ 65 years old). METHODS This review followed PRISMA guidelines. Studies were identified from PubMed, PsycINFO, Embase, CINAHL and Web of Science. Study selection was conducted independently by four reviewers working in pairs. Included studies reported data on interventions designed to increase adherence to statin therapy in older adults and were original trials or observational studies. Interventions were pragmatically regrouped into 8 different categories going from patient to administrative level. Two reviewers extracted study data and assessed study quality independently. Given the heterogeneity between the included studies, a narrative critique and summary was conducted. RESULTS Twelve out of the 2889 identified articles were included in the review. Our review showed that simplifying patients' drug regimen, administrative improvements and large-scale pharmacy-led automated telephone interventions show positive effects on patient adherence to statin therapy, with odds ratios between > 1.0 and 3.0, while education-based strategies and intensified patient care showed mixed results. CONCLUSIONS Current evidence suggests that some interventions can increase statin adherence in older adults, which could help in the reduction of the risk of a cardiovascular event in this population.
Collapse
Affiliation(s)
- Philipp Frieden
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec - Université Laval, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, local J1-11, Quebec City, QC, G1S 4L8, Canada
- Faculté de médecine, Université Laval, Quebec City, QC, Canada
- Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, Quebec City, QC, Canada
| | - Rose Gagnon
- Faculté de médecine, Université Laval, Quebec City, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Quebec City, QC, Canada
| | - Élodie Bénard
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec - Université Laval, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, local J1-11, Quebec City, QC, G1S 4L8, Canada
- Faculté de médecine, Université Laval, Quebec City, QC, Canada
- Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, Quebec City, QC, Canada
| | - Benoît Cossette
- Centre de recherche sur le vieillissement du CIUSSS de l'Estrie - CHUS, Sherbrooke, QC, Canada
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Denis Talbot
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec - Université Laval, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, local J1-11, Quebec City, QC, G1S 4L8, Canada
- Faculté de médecine, Université Laval, Quebec City, QC, Canada
| | - Jason Robert Guertin
- Axe Santé des Populations et Pratiques Optimales en Santé, Centre de recherche du CHU de Québec - Université Laval, Hôpital du Saint-Sacrement, 1050 chemin Sainte-Foy, local J1-11, Quebec City, QC, G1S 4L8, Canada.
- Faculté de médecine, Université Laval, Quebec City, QC, Canada.
- Centre de recherche en organogénèse expérimentale de l'Université Laval/LOEX, Quebec City, QC, Canada.
| |
Collapse
|
2
|
Campbell DJT, Lee-Krueger RCW, McBrien K, Anderson T, Quan H, Leung AA, Chen G, Lu M, Naugler C, Butalia S. Strategies for enhancing the initiation of cholesterol lowering medication among patients at high cardiovascular disease risk: a qualitative descriptive exploration of patient and general practitioners' perspectives on a facilitated relay intervention in Alberta, Canada. BMJ Open 2020; 10:e038469. [PMID: 33234627 PMCID: PMC7689086 DOI: 10.1136/bmjopen-2020-038469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/17/2020] [Accepted: 10/28/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The objective of our study was to explore the perspectives of patients and general practitioners (GPs) regarding interventions to increase initiation of cholesterol lowering medication (or statins), including a proposed laboratory-based facilitated relay intervention. DESIGN Qualitative descriptive study using interviews and focus groups for data collection, and thematic analysis for data analysis. SETTING Primary care providers and patients in Calgary, Alberta, Canada. PARTICIPANTS 17 GPs with primarily community-based, non-academic practices with at least 1 year of practice experience participated in semistructured interviews. 14 patients at high risk of cardiovascular disease participated in focus groups. MAIN OUTCOME MEASURES Exploration of strategies that might be used to enhance the prescription of, and adherence to statin therapy for patients with statin-indicated conditions. RESULTS GPs proposed a variety of interventions to improve statin prescription, including electronic record audit solutions, GP directed education, and patient-oriented campaigns. Patients expressed that they may benefit from being provided access to their laboratory test results, as well as targeted education. Both parties provided positive feedback on the proposed laboratory-based facilitated relay intervention, while pointing out areas for improvement. Notably, GPs were concerned that the patient-directed component of the intervention might jeopardise therapeutic relationships, and patients were concerned about accidental disclosure of personal health information. Important considerations for the design of facilitated relay messaging should include brevity, simplicity and the provision of contact information for inquiries. CONCLUSIONS GPs and patients described several suggestions for increasing statin initiation and welcomed the proposal of a laboratory-based facilitated relay strategy. These findings support further testing of this intervention which may enhance GPs' ability to successfully engage patients in cardiovascular risk reduction through statin therapy.
Collapse
Affiliation(s)
- David J T Campbell
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Kerry McBrien
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Todd Anderson
- Department of Cardiac Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Guanmin Chen
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mingshan Lu
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Naugler
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
3
|
A pragmatic controlled trial to improve the appropriate prescription of drugs in adult outpatients: design and rationale of the EDU.RE.DRUG study. Prim Health Care Res Dev 2020. [PMCID: PMC7372175 DOI: 10.1017/s1463423620000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: Pharmacological intervention is an important component of patient care. However, drugs are often inappropriately used. It is necessary for countries to implement strategies to improve the rational use of drugs, including independent information for healthcare professionals and the public, which must be supported by well-trained staff. The primary objectives of the EDU.RE.DRUG (Effectiveness of informative and/or educational interventions aimed at improving the appropriate use of drugs designed for general practitioners and their patients) study are the retrospective evaluation of rates of appropriate prescribing indicators (APIs) and the assessment of the effectiveness of informative and/or educational interventions addressed to general practitioners (GPs) and their patients, aimed at improving prescribing quality and promoting proper drug use. Methods and analysis: This is a prospective, multicentre, open-label, parallel-arm, controlled, pragmatic trial directed to GPs and their patients in two Italian regions (Campania and Lombardy). The study data are retrieved from administrative databases (Demographic, Pharmacy-refill, and Hospitalization databases) containing healthcare information of all beneficiaries of the National Health Service in the Local Health Units (LHUs) involved. According to LHU, the GPs/patients will be assigned to one of the following four intervention arms: (1) intervention on GPs and patients; (2) intervention on GPs; (3) intervention on patients; and (4) no intervention (control). The intervention designed for GPs consists of reports regarding the status of their patients according to the APIs determined at baseline and in two on-line Continuous Medical Education (CME) courses. The intervention designed for patients consists in flyers and posters distributed in GPs ambulatories and community pharmacies, focusing on correct drug use. A set of indicators (such as potential drug–drug interactions, unnecessary duplicate prescriptions, and inappropriate prescriptions in the elderly), adapted to the Italian setting, has been defined to determine inappropriate prescription at baseline and after the intervention phase. The primary outcome was a composite API. Ethics and dissemination: The study was approved by the Ethics Committee of the University of Milan on 7th June 2017 (code 15/17). The investigators will communicate trial results to stakeholders, collaborators, and participants via appropriate presentations and publications. Registration details: NCT04030468. EudraCT number 2017-002622-21
Collapse
|
4
|
Vonbank A, Agewall S, Kjeldsen KP, Lewis BS, Torp-Pedersen C, Ceconi C, Funck-Brentano C, Kaski JC, Niessner A, Tamargo J, Walther T, Wassmann S, Rosano G, Schmidt H, Saely CH, Drexel H. Comprehensive efforts to increase adherence to statin therapy. Eur Heart J 2019; 38:2473-2479. [PMID: 28077470 DOI: 10.1093/eurheartj/ehw628] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 12/06/2016] [Indexed: 12/26/2022] Open
Affiliation(s)
- Alexander Vonbank
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Stefan Agewall
- Oslo University Hospital Ullevål and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Keld Per Kjeldsen
- Division of Cardiology, Department of Medicine, Copenhagen University Hospital (Holbaek Hospital), Holbaek, Denmark.,Department of Health Science and Technology, The Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Basil S Lewis
- Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine of the Technion (Israel Institute of Technology), Haifa, Israel
| | - Christian Torp-Pedersen
- Health Science and Technology, Aalborg University, Niels Jernes Vej 12, A5-208, 9220 Aalborg, Denmark
| | - Claudio Ceconi
- University Hospital of Ferrara, U.O. Cardiologia, Post Degree School in Cardiology, Heart Failure and Cardiovascular Prevention Unit, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy
| | - Christian Funck-Brentano
- INSERM, CIC-1421 and UMR ICAN 1166, AP-HP, Pitié-Salpêtrière Hospital, Department of Pharmacology, Sorbonne Universités, UPMC Univ Paris, 06, Faculty of Medicine, F-75013 Paris, France
| | - Juan Carlos Kaski
- Cardiovascular Sciences Research Centre at St George's, University of London, Cranmer Terrace, London SW17 0RE, Great Britain
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Juan Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Thomas Walther
- Department of Pharmacology and Therapeutics, University College Cork, Cork, Ireland.,Department of Obstetrics, Center for Perinatal Medicine, University of Leipzig, Leipzig, Germany
| | - Sven Wassmann
- Department of Cardiology, Isar Heart Center, Isarklinikum, Sonnenstr. 24-26, 80331 Munich, Germany
| | - Giuseppe Rosano
- Irccs San Raffaele Hospital, Department of Medical Sciences, Via Della Pisana 235, 00163 Rome, Italy
| | - Harald Schmidt
- Department of Health, Medicine and Life Sciences, Pharmacology, University of Maastricht Universiteitssingel 50, 6229 Maastricht, The Netzerlands
| | - Christoph H Saely
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein
| | - Heinz Drexel
- Department of Medicine and Cardiology, Academic Teaching Hospital and VIVIT Institute Carinagasse 47, 6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, 9495 Triesen, Liechtenstein.,College of Medicine, Drexel University, Philadelphia, PA, USA
| |
Collapse
|
5
|
Sessa M, Rafaniello C, Scavone C, Mascolo A, di Mauro G, Fucile A, Rossi F, Sportiello L, Capuano A. Preventable statin adverse reactions and therapy discontinuation. What can we learn from the spontaneous reporting system? Expert Opin Drug Saf 2018; 17:457-465. [PMID: 29619841 DOI: 10.1080/14740338.2018.1458837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Statin treatment is often associated with poor adherence, which may be due to the onset of adverse drug reactions (ADRs). We investigated on potential risk factors related to preventable cases of statin-induced ADRs and to the discontinuation of statin therapy. METHODS We performed a study using the database of Italian spontaneous reporting. The target population for the preventability assessment was all patients with suspected statin-induced ADRs deriving from Campania Region (a territory of Southern Italy) between 2012 and 2017. Additionally, a local sentinel surveillance site involving General Practitioners was selected to countercheck in routine clinical practice the role of ADRs for statin discontinuation. RESULTS In total, 34 of 655 (5.19%) regional cases were preventable and among detected risk factors 90.0% was related to healthcare professionals' practices and 10.0% to patient behaviour. In 81.4% (533/655) of cases, statin therapy was discontinued due to ADRs, mainly classified as not serious and associated with a positive prognosis. These results were also confirmed in the active sentinel site. CONCLUSIONS Our findings suggest an inappropriate use of statins among the identified preventable cases and a potential inappropriate statin discontinuation due to ADRs. These factors may be useful for targeting interventions to improve statin adherence.
Collapse
Affiliation(s)
- Maurizio Sessa
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Concetta Rafaniello
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Cristina Scavone
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Annamaria Mascolo
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Gabriella di Mauro
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Annamaria Fucile
- b Pharmaceutical department , Local Health Unit of Caserta , Caserta , Italy
| | - Francesco Rossi
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Liberata Sportiello
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Annalisa Capuano
- a Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli" , University of Campania "Luigi Vanvitelli" , Naples , Italy
| |
Collapse
|
6
|
Kaya H, Beton O, Yilmaz MB. How to increase level of patients' awareness regarding the importance of statins despite the influence of the media? Int J Cardiol 2016; 207:164. [DOI: 10.1016/j.ijcard.2016.01.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/03/2016] [Indexed: 11/25/2022]
|