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Osbaugh NA, Billups SJ. A shared
decision‐making
intervention by pharmacy students to improve statin adherence. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Nicole A. Osbaugh
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora Colorado USA
| | - Sarah J. Billups
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences Aurora Colorado USA
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Vadhariya A, Paranjpe R, Essien EJ, Johnson ML, Fleming ML, Esse TW, Gallardo E, Serna O, Choi J, Boklage S, Abughosh SM. Patient-reported barriers to statin adherence: Excerpts from a motivational interviewing intervention in older adults. J Am Pharm Assoc (2003) 2020; 61:60-67.e1. [PMID: 33032947 DOI: 10.1016/j.japh.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Despite a known benefit in the reduction of cardiovascular risk, adherence to statins remains suboptimal. A qualitative analysis was conducted within an intervention that identified trajectories of statin adherence in patients and used motivational interviewing (MoI) to improve adherence. The objective of this qualitative study was to evaluate transcripts of an MoI telephonic intervention to identify potential, past, and current barriers to statin adherence and barriers specific to distinct adherence trajectories. METHODS The MoI intervention was customized by past 1-year adherence trajectories (rapid discontinuation, gradual decline, and gaps in adherence). Two authors independently extracted and documented barriers from phone transcripts. Themes were derived from literature a priori and by cataloging recurring themes from the transcripts. RESULTS The transcripts of calls made to 157 patients were reviewed of which 25.2% did not communicate a specific adherence barrier despite falling into a low-adherence trajectory when examining refill data. The most commonly reported barriers to statin adherence included adverse effects (40.1%), forgetfulness (30.0%), and lack of skills or knowledge pertaining to statins (25%). More patients in the rapid discontinuation group perceived medication as unnecessary, whereas more patients in the gaps in adherence group reported a communication barrier with their health care provider. Several barriers among patients who fell into low-adherence trajectories were reported. Some patients did not report any barriers, which may have indicated denial. MoI phone calls were useful in providing knowledge, clarifying medication regimens, and reinforcing the need to take statins. CONCLUSION This study identified patient-reported barriers to statin adherence elicited during an MoI telephonic intervention conducted by student pharmacists. There were differences in barriers reported by patients from each trajectory, which emphasize the need for additional tailored interventions to improve patient adherence.
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Hains I, Raffoul N, Yoo J. Evaluation of academic detailing visits on GP knowledge and practice for statin use and management. Aust J Prim Health 2020; 26:492-499. [PMID: 33004108 DOI: 10.1071/py20062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/14/2020] [Indexed: 11/23/2022]
Abstract
Dyslipidaemia is a major risk factor for cardiovascular disease (CVD) and is routinely managed by GPs. Lipid-modifying medicines, commonly statins, are used to treat dyslipidaemia and prevent CVD in high-risk individuals. A national education program for over 8000 Australian GPs was delivered and evaluated. The program aimed to optimise the use of statins and provide GPs with an Australian-developed statin-associated muscle symptoms (SAMS) management algorithm supporting assessment and management of suspected SAMS. Retrospective pre-test and control questionnaires were administered to measure changes in knowledge and intended practice following the education program. A total of 226 participant GPs and 150 control GPs completed the questionnaires. The program led to positive changes in GP knowledge and intended practice around the use of absolute CVD risk to make prescribing decisions. Participant GPs demonstrated increased knowledge, compared with control GPs, about the use of CVD risk calculators as the most effective approach to lipid management, and adequately trialling a statin before considering a second agent. One of the greatest improvements in participant GP-intended practice related to the assessment and management of suspected SAMS, with participant GPs more likely to appropriately identify and manage suspected SAMS than control GPs.
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Affiliation(s)
- Isla Hains
- NPS MedicineWise, PO Box 1147, Strawberry Hills, NSW 2012, Australia; and Corresponding author.
| | - Natalie Raffoul
- NPS MedicineWise, PO Box 1147, Strawberry Hills, NSW 2012, Australia
| | - Jeannie Yoo
- NPS MedicineWise, PO Box 1147, Strawberry Hills, NSW 2012, Australia
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McClellan M, Brown N, Califf RM, Warner JJ. Call to Action: Urgent Challenges in Cardiovascular Disease: A Presidential Advisory From the American Heart Association. Circulation 2019; 139:e44-e54. [PMID: 30674212 DOI: 10.1161/cir.0000000000000652] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although advances in care have spurred improvements in cardiovascular outcomes, cardiovascular disease remains the leading cause of death in the United States and around the world. Previous declines in cardiovascular disease mortality have slowed and even reversed for certain demographics. Further concerns exist with regard to cardiovascular drug innovation, quality of care, and healthcare costs. The Value in Healthcare Initiative-Transforming Cardiovascular Care, a collaboration of the American Heart Association and Duke University, Robert J. Margolis, MD, Center for Health Policy, aims to increase access to and affordability of cardiovascular treatment and to decrease barriers to care. The following Call to Action describes trends in cardiovascular care, identifies gaps in areas of cardiovascular disease prevention and treatment, highlights challenges with medical product innovation, and finally, outlines a series of learning collaboratives that will aid in the development of road maps for transforming cardiovascular care.
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Oñatibia-Astibia A, Malet-Larrea A, Larrañaga B, Gastelurrutia MÁ, Calvo B, Ramírez D, Cantero I, Garay Á, Goyenechea E. Tailored interventions by community pharmacists and general practitioners improve adherence to statins in a Spanish randomized controlled trial. Health Serv Res 2019; 54:658-668. [PMID: 30957240 DOI: 10.1111/1475-6773.13152] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To evaluate the impact of health professionals' intervention on adherence to statins, the influence on total cholesterol levels, and lifestyle patterns in patients with hypercholesterolemia and analyze the differences according to the center of recruitment. STUDY SETTING Forty-six community pharmacies and 50 primary care centers of Spain. STUDY DESIGN Randomized controlled trial design (n = 746). Patients were assigned into adherent (ADH) or nonadherent group depending on their initial adherence to statins. Nonadherent patients were randomly assigned to intervention (INT) or nonintervention (NOINT) group. Patients enrolled in the INT group received an intervention depending on the cause of nonadherence. Patients in the ADH and NOINT groups received usual care. Intention-to-treat (ITT) analysis was performed with multiple imputation to replace the missing data. DATA COLLECTION Adherence, total cholesterol levels, and lifestyle behaviors. FINDINGS The odds of becoming adherent during the 6 months was higher in the INT group compared to the NOINT group (OR = 1,49; 95% CI: 1.30-1.76; P < 0.001), especially in the community pharmacy group (OR = 2.34; 95% CI: 1.81-3.03; P < 0.001). Adherent patients showed lower values of total cholesterol compared with nonadherent patients at baseline (ADH: 200.3 mg/dL vs NOADH: 216.7 mg/dL; P < 0.001) and at the endpoint (ADH: 197.3 mg/dL vs NOADH: 212.2 mg/dL; P < 0.001). More patients enrolled in the INT group practices exercise at the end of the study (INT: +26.6 percent; P = 0.002), and a greater number of patients followed a diet to treat hypercholesterolemia (+30.2 percent; P < 0.001). CONCLUSIONS The intervention performed by health professionals, especially by community pharmacists, improved adherence to statins by hypercholesterolemic patients, and this improvement in adherence was accompanied by a reduction in total cholesterol levels and a healthier lifestyle.
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Affiliation(s)
| | - Amaia Malet-Larrea
- Official Pharmacist Association of Gipuzkoa, Donostia/San Sebastián, Spain
| | - Belen Larrañaga
- Official Pharmacist Association of Gipuzkoa, Donostia/San Sebastián, Spain
| | | | - Begoña Calvo
- Pharmaceutical Technology Department, Faculty of Pharmacy, University of the Basque Country, Vitoria, Spain
| | | | | | - Ángel Garay
- Official Pharmacist Association of Gipuzkoa, Donostia/San Sebastián, Spain
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Banegas MP, Emerson MA, Adams AS, Achacoso NS, Chawla N, Alexeeff S, Habel LA. Patterns of medication adherence in a multi-ethnic cohort of prevalent statin users diagnosed with breast, prostate, or colorectal cancer. J Cancer Surviv 2018; 12:794-802. [PMID: 30338462 DOI: 10.1007/s11764-018-0716-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 09/11/2018] [Indexed: 01/16/2023]
Abstract
PURPOSE To investigate the implications of a cancer diagnosis on medication adherence for pre-existing comorbid conditions, we explored statin adherence patterns prior to and following a new diagnosis of breast, colorectal, or prostate cancer among a multi-ethnic cohort. METHODS We identified adults enrolled at Kaiser Permanente Northern California who were prevalent statin medication users, newly diagnosed with breast, colorectal, or prostate cancer between 2000 and 2012. Statin adherence was measured using the proportion of days covered (PDC) during the 2-year pre-cancer diagnosis and the 2-year post-cancer diagnosis. Adherence patterns were assessed using generalized estimating equations, for all cancers combined and stratified by cancer type and race/ethnicity, adjusted for demographic, clinical, and tumor characteristics. RESULTS Among 10,177 cancer patients, statin adherence decreased from pre- to post-cancer diagnosis (adjusted odds ratio (ORadj):0.91, 95% confidence interval (95% CI):0.88-0.94). Statin adherence decreased from pre- to post-cancer diagnosis among breast (ORadj:0.94, 95% CI:0.90-0.99) and colorectal (ORadj:0.79, 95% CI:0.74-0.85) cancer patients. No difference in adherence was observed among prostate cancer patients (ORadj:1.01, 95% CI:0.97-1.05). Prior to cancer diagnosis, adherence to statins was generally higher among non-Hispanic whites and multi-race patients than other groups. However, statin adherence after diagnosis decreased only among these two populations (ORadj:0.85, 95% CI:0.85-0.92 and ORadj:0.86, 95% CI:0.76-0.97), respectively. CONCLUSIONS We found substantial variation in statin medication adherence following diagnosis by cancer type and race/ethnicity among a large cohort of prevalent statin users in an integrated health care setting. IMPLICATIONS FOR CANCER SURVIVORS Improving our understanding of comorbidity management and polypharmacy across diverse cancer patient populations is warranted to develop tailored interventions that improve medication adherence and reduce disparities in health outcomes.
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Affiliation(s)
- Matthew P Banegas
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227-1110, USA.
| | - Marc A Emerson
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Alyce S Adams
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | | | - Neetu Chawla
- Division of Research, Kaiser Permanente, Oakland, CA, USA
| | | | - Laurel A Habel
- Division of Research, Kaiser Permanente, Oakland, CA, USA
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Tan C, Hassali M, Neoh C, Saleem F, Horne R. Cultural Adaptation and Linguistic Validation of the Beliefs about Medicines Questionnaire in Malaysia. Value Health Reg Issues 2018; 15:161-168. [DOI: 10.1016/j.vhri.2017.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/29/2017] [Accepted: 12/03/2017] [Indexed: 02/08/2023]
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Piette AB, Dufresne SS, Frenette J. A short-term statin treatment changes the contractile properties of fast-twitch skeletal muscles. BMC Musculoskelet Disord 2016; 17:449. [PMID: 27793139 PMCID: PMC5084426 DOI: 10.1186/s12891-016-1306-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 10/21/2016] [Indexed: 01/19/2023] Open
Abstract
Background Cumulative evidence indicates that statins induce myotoxicity. However, the lack of understanding of how statins affect skeletal muscles at the structural, functional, and physiological levels hampers proper healthcare management. The purpose of the present study was to investigate the early after-effects of lovastatin on the slow-twitch soleus (Sol) and fast-twitch extensor digitorum longus (EDL) muscles. Methods Adult C57BL/6 mice were orally administrated with placebo or lovastatin [50 mg/kg/d] for 28 days. At the end of the treatment, the isometric ex vivo contractile properties of the Sol and EDL muscles were measured. Subtetanic and tetanic contractions were assessed and contraction kinetics were recorded. The muscles were then frozen for immunohistochemical analyses. Data were analyzed by two-way ANOVA followed by an a posteriori Tukey’s test. Results The short-term lovastatin treatment did not induce muscle mass loss, muscle fiber atrophy, or creatine kinase (CK) release. It had no functional impact on slow-twitch Sol muscles. However, subtetanic stimulations at 10 Hz provoked greater force production in fast-twitch EDL muscles. The treatment also decreased the maximal rate of force development (dP/dT) of twitch contractions and prolonged the half relaxation time (1/2RT) of tetanic contractions of EDL muscles. Conclusions An early short-term statin treatment induced subtle but significant changes in some parameters of the contractile profile of EDL muscles, providing new insights into the selective initiation of statin-induced myopathy in fast-twitch muscles.
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Affiliation(s)
- Antoine Boulanger Piette
- Centre Hospitalier Universitaire de Québec, Centre de Recherche du Centre Hospitalier de l'Université Laval (CHUQ-CHUL), Axe Neurosciences, Université Laval, Quebec City, QC, G1V 4G2, Canada
| | - Sébastien S Dufresne
- Centre Hospitalier Universitaire de Québec, Centre de Recherche du Centre Hospitalier de l'Université Laval (CHUQ-CHUL), Axe Neurosciences, Université Laval, Quebec City, QC, G1V 4G2, Canada
| | - Jérôme Frenette
- Centre Hospitalier Universitaire de Québec, Centre de Recherche du Centre Hospitalier de l'Université Laval (CHUQ-CHUL), Axe Neurosciences, Université Laval, Quebec City, QC, G1V 4G2, Canada. .,Département de Réadaptation, Faculté de Médecine, Université Laval, Quebec City, QC, G1V 0A6, Canada.
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Abstract
Although many clinical trials and meta-analyses have demonstrated that lower serum low-density lipoprotein cholesterol (LDL-C) levels are associated with proportionately greater reductions in the risk of cardiovascular disease events, not all patients with hypercholesterolemia are able to attain risk-stratified LDL-C goals with statin monotherapy. Elucidation of the pathophysiology of genetic disorders of lipid metabolism (e.g., familial hypercholesterolemia) has led to the development of several novel lipid-lowering strategies, including blocking the degradation of hepatic LDL-C receptors that are important in LDL-C clearance, or the inhibition of apoprotein synthesis and lipidation. Mipomersen and lomitapide are highly efficacious new agents available for the treatment of patients with homozygous familial hypercholesterolemia. The recent introduction of PCSK9 inhibitors (alirocumab and evolocumab) have made it possible for many patients to achieve very low LDL-C concentrations (e.g., <40 mg/dl) that are usually not attainable with statin monotherapy. Ongoing clinical trials are examining the impact of very low LDL-C levels on cardiovascular disease event rates and the long-term safety of this approach.
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Affiliation(s)
- Peter P Toth
- Community General Hospital Medical Center, Sterling, Illinois; University of Illinois School of Medicine, Peoria, Illinois; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Mueller SM, Itin P, Vogt DR, Walter M, Lang U, Griffin LL, Euler S. Assessment of “corticophobia” as an indicator of non-adherence to topical corticosteroids: A pilot study. J DERMATOL TREAT 2016; 28:104-111. [DOI: 10.1080/09546634.2016.1201189] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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