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Ngo S, Asirvatham R, Baird GL, Sarraju A, Maron DJ, Rodriguez F. Readability and reliability of online patient education materials about statins. Am J Prev Cardiol 2023; 16:100594. [PMID: 37822580 PMCID: PMC10562660 DOI: 10.1016/j.ajpc.2023.100594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023] Open
Abstract
Objective Statins are the cornerstone for the prevention and treatment of cardiovascular disease. Patients often consult online patient education materials (OPEMs) to inform medical decision-making. We therefore aimed to assess the readability and reliability of OPEMs related to statins. Methods A total of 17 statin-related terms were queried using an online search engine to identify the top 20 search results for each statin-related term. Each OPEM was then grouped into the following categories based on 2 independent reviewers: government OPEMs (national, state, or local government agencies); healthcare/nonprofit OPEMs (major health systems and nonprofit organizations with a specific cardiovascular health focus); industry/commercial OPEMs (pharmaceutical manufacturers and online pharmacies); lay press OPEMs (healthcare-oriented news organizations); and dictionary/encyclopedia OPEMs. Grade-level readability for each OPEM was calculated using 5 standard readability metrics and compared with AMA-recommended readability recommendations. Reliability of each OPEM was evaluated using the JAMA benchmark criteria for online health information and certification from Health on the Net (HONCode). Results A total of 340 websites were identified across the 17 statin search terms. There were 211 statin OPEMs after excluding non-OPEM results; 172 OPEMs had unique content. Statin OPEM readability exceeded the recommended 6th grade AMA reading level (average reading grade level of 10.9). The average JAMA benchmark criteria score was 2.13 (on a scale of 0-4, with higher scores indicating higher reliability), and only 60% of statin OPEMs were HONCode-certified. There was an inverse association between readability and reliability. The most readable results were from industry and commercial sources, while the most reliable sites were from lay press sources. Conclusions Statin OPEMs are written at an overall averaging reading grade level of 10.9. There was an inverse association between readability and reliability. Lack of accessible, high-quality online health information may contribute to statin nonadherence.
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Affiliation(s)
- Summer Ngo
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Grayson L. Baird
- Diagnostic Imaging, Rhode Island Hospital and Alpert Medical School, Brown University, Providence, RI, USA
| | - Ashish Sarraju
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David J. Maron
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
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2
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Schulz M, Laufs U. Not obtaining a medication the first time it is prescribed: primary non-adherence to cardiovascular pharmacotherapy. Clin Res Cardiol 2023:10.1007/s00392-023-02230-3. [PMID: 37209148 DOI: 10.1007/s00392-023-02230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
Primary medication non-adherence describes the situation when a first prescription for a new medication is never filled. Primary non-adherence is an important, yet understudied aspect of reduced effectiveness of pharmacotherapy. This review summarizes the frequency, impact, reasons, predictors, and interventions regarding primary non-adherence to cardiovascular/cardiometabolic drugs. The current literature reveals a high prevalence of primary non-adherence. The individual risk of primary non-adherence is determined on multiple factors, e.g., primary non-adherence of lipid-lowering drugs is higher compared to antihypertensive medications. However, the overall rate of primary non-adherence is > 10%. Additionally, this review identifies specific areas for research to better understand why patients forgo evidence-based beneficial pharmacotherapy and to explore targeted interventions. At the same time, measures to reduce primary non-adherence-once proven to be effective-may represent an important new opportunity to reduce cardiovascular diseases.
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Affiliation(s)
- Martin Schulz
- Institute of Pharmacy, Freie Universität Berlin, Kelchstraße 31, 12169, Berlin, Germany.
- Drug Commission of German Pharmacists (AMK), Heidestraße 7, 10557, Berlin, Germany.
- German Institute for Drug Use Evaluation (DAPI), Heidestraße 7, 10557, Berlin, Germany.
| | - Ulrich Laufs
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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3
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Menichetti J, Lie HC, Mellblom AV, Brembo EA, Eide H, Gulbrandsen P, Heyn L, Saltveit KH, Strømme H, Sundling V, Turk E, Juvet LK. Tested communication strategies for providing information to patients in medical consultations: A scoping review and quality assessment of the literature. PATIENT EDUCATION AND COUNSELING 2021; 104:1891-1903. [PMID: 33516591 DOI: 10.1016/j.pec.2021.01.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/18/2020] [Accepted: 01/16/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To systematize the scientific knowledge of empirically tested strategies for verbally providing medical information in patient-physician consultations. METHODS A scoping review searching for terms related to physician, information, oral communication, and controlled study. Four pairs of reviewers screened articles. For each selected study, we assessed the quality and summarized aspects on participants, study, intervention, and outcomes. Information provision strategies were inductively classified by types and main categories. RESULTS After screening 9422 articles, 39 were included. The methodological quality was moderate. We identified four differently used categories of strategies for providing information: cognitive aid (n = 13), persuasive (n = 8), relationship- (n = 3), and objectivity-oriented strategies (n = 4); plus, one "mixed" category (n = 11). Strategies were rarely theoretically derived. CONCLUSIONS Current research of tested strategies for verbally providing medical information is marked by great heterogeneity in methods and outcomes, and lack of theory-driven approaches. The list of strategies could be used to analyse real life communication. PRACTICE IMPLICATIONS Findings may aid the harmonization of future efforts to develop empirically-based information provision strategies to be used in clinical and teaching settings.
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Affiliation(s)
- Julia Menichetti
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Hanne C Lie
- Department of Behavioral Medicine, University of Oslo, Oslo, Norway.
| | - Anneli V Mellblom
- Department of Behavioral Medicine, University of Oslo, Oslo, Norway; Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway.
| | - Espen Andreas Brembo
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Hilde Eide
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Health Services Research (HØKH) Centre, Akershus University Hospital, Lørenskog, Norway.
| | - Lena Heyn
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.
| | | | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Oslo, Norway.
| | - Vibeke Sundling
- Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway.
| | - Eva Turk
- Science Centre Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway; Medical Faculty, University of Maribor, Maribor, Slovenia.
| | - Lene K Juvet
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway; Norvegian Institute of Public Health, Oslo, Norway.
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Jones LK, Tilberry S, Gregor C, Yaeger LH, Hu Y, Sturm AC, Seaton TL, Waltz TJ, Rahm AK, Goldberg A, Brownson RC, Gidding SS, Williams MS, Gionfriddo MR. Implementation strategies to improve statin utilization in individuals with hypercholesterolemia: a systematic review and meta-analysis. Implement Sci 2021; 16:40. [PMID: 33849601 PMCID: PMC8045284 DOI: 10.1186/s13012-021-01108-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/29/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Numerous implementation strategies to improve utilization of statins in patients with hypercholesterolemia have been utilized, with varying degrees of success. The aim of this systematic review is to determine the state of evidence of implementation strategies on the uptake of statins. METHODS AND RESULTS This systematic review identified and categorized implementation strategies, according to the Expert Recommendations for Implementing Change (ERIC) compilation, used in studies to improve statin use. We searched Ovid MEDLINE, Embase, Scopus, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov from inception to October 2018. All included studies were reported in English and had at least one strategy to promote statin uptake that could be categorized using the ERIC compilation. Data extraction was completed independently, in duplicate, and disagreements were resolved by consensus. We extracted LDL-C (concentration and target achievement), statin prescribing, and statin adherence (percentage and target achievement). A total of 258 strategies were used across 86 trials. The median number of strategies used was 3 (SD 2.2, range 1-13). Implementation strategy descriptions often did not include key defining characteristics: temporality was reported in 59%, dose in 52%, affected outcome in 9%, and justification in 6%. Thirty-one trials reported at least 1 of the 3 outcomes of interest: significantly reduced LDL-C (standardized mean difference [SMD] - 0.17, 95% CI - 0.27 to - 0.07, p = 0.0006; odds ratio [OR] 1.33, 95% CI 1.13 to 1.58, p = 0.0008), increased rates of statin prescribing (OR 2.21, 95% CI 1.60 to 3.06, p < 0.0001), and improved statin adherence (SMD 0.13, 95% CI 0.06 to 0.19; p = 0.0002; OR 1.30, 95% CI 1.04 to 1.63, p = 0.023). The number of implementation strategies used per study positively influenced the efficacy outcomes. CONCLUSION Although studies demonstrated improved statin prescribing, statin adherence, and reduced LDL-C, no single strategy or group of strategies consistently improved outcomes. TRIAL REGISTRATION PROSPERO CRD42018114952 .
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Affiliation(s)
- Laney K Jones
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA.
| | - Stephanie Tilberry
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Christina Gregor
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA
| | - Lauren H Yaeger
- Bernard Becker Medical Library, Washington University in St. Louis, St. Louis, MO, USA
| | - Yirui Hu
- Population Health Sciences, Geisinger, Danville, PA, USA
| | - Amy C Sturm
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Terry L Seaton
- University of Health Sciences and Pharmacy in St. Louis, St. Louis, MO, USA
- Population Health, Mercy Clinic-East Communities, St. Louis, MO, USA
| | | | - Alanna K Rahm
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Anne Goldberg
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Samuel S Gidding
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, 100 N Academy Ave., Danville, PA, 17822, USA
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Hussain A, Asif M, Jameel A, Hwang J, Sahito N, Kanwel S. Promoting OPD Patient Satisfaction through Different Healthcare Determinants: A Study of Public Sector Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193719. [PMID: 31581643 PMCID: PMC6801450 DOI: 10.3390/ijerph16193719] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 11/16/2022]
Abstract
Patient satisfaction is a core tool for measuring the performance of the hospitals as well as the service provider and the services that they are providing to the patients. The aim of this research is to evaluate how information received, medical equipment, distance from the hospital, and physical infrastructure influenced patient satisfaction at public hospitals in Southern Punjab, Pakistan. An exploratory research technique was used. We distributed 700 questionnaires through a random method, and 579 provided proper responses. A confirmatory factor analysis (CFA) and a regression analysis were used for the data analysis. The study results illustrated that medical equipment, information received, distance from the hospital, and physical infrastructure had significantly positive impacts (p = 0.001) on patient satisfaction. To promote higher level of satisfaction, there is a need to take appropriate steps for improvement.
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Affiliation(s)
- Abid Hussain
- School of Public Affairs, Zijingang Campus, Zhejiang University, Hangzhou 310058, China.
| | - Muhammad Asif
- School of Public Affairs, Zijingang Campus, Zhejiang University, Hangzhou 310058, China.
| | - Arif Jameel
- School of Public Affairs, Zijingang Campus, Zhejiang University, Hangzhou 310058, China.
| | - Jinsoo Hwang
- The College of Hospitality and Tourism Management, Sejong University, 98Gunja-Dong, Gwanjin-Gu, Seoul 143-747, Korea.
| | - Noman Sahito
- Department of City & Regional Planning, Mehran University of Engineering & Technology, Jamshoro 76062, Pakistan.
| | - Shahida Kanwel
- Tourism & Hotel Management, School of Management, Zhejiang University, Hangzhou 310058, China.
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Fernandez-Lazaro CI, García-González JM, Adams DP, Fernandez-Lazaro D, Mielgo-Ayuso J, Caballero-Garcia A, Moreno Racionero F, Córdova A, Miron-Canelo JA. Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC FAMILY PRACTICE 2019; 20:132. [PMID: 31521114 PMCID: PMC6744672 DOI: 10.1186/s12875-019-1019-3] [Citation(s) in RCA: 123] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022]
Abstract
Background Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings. Methods A cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence using the Multidimensional Model proposed by the World Health Organization — social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Results The proportion of adherent patients to treatment was 55.5%. Older age (adjusted odds ratio 1.31 per 10-year increment, 95% CI 1.01–1.70), lower number of pharmacies used for medication refills (0.65, 95% CI 0.47–0.90), having received complete treatment information (3.89, 95% CI 2.09–7.21), having adequate knowledge about medication regimen (4.17, 95% CI 2.23–7.80), and self-perception of a good quality of life (2.17, 95% CI 1.18–4.02) were independent factors associated with adherence. Conclusions Adherence to treatment for chronic conditions remained low in primary care. Optimal achievement of appropriate levels of adherence through tailored multifaceted interventions will require attention to the multidimensional factors found in this study, particularly those related to patients’ education and their information needs. Electronic supplementary material The online version of this article (10.1186/s12875-019-1019-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cesar I Fernandez-Lazaro
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, Calle Alfonso X el Sabio s/n, 37007, Salamanca, Spain. .,Department of Preventive Medicine and Public Health, School of Medicine, IDISNA, University of Navarra, Pamplona, Spain.
| | | | - David P Adams
- Dual Enrollment Program, Point University-Savannah Campus, Savannah, GA, USA
| | - Diego Fernandez-Lazaro
- Department of Cell Biology, Histology and Pharmacology, University of Valladolid, Soria, Spain
| | - Juan Mielgo-Ayuso
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Physical Therapy, University of Valladolid, Soria, Spain
| | | | | | - Alfredo Córdova
- Department of Biochemistry, Molecular Biology and Physiology, Faculty of Physical Therapy, University of Valladolid, Soria, Spain
| | - Jose A Miron-Canelo
- Department of Biomedical and Diagnostic Sciences, School of Medicine, University of Salamanca, Calle Alfonso X el Sabio s/n, 37007, Salamanca, Spain
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7
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Cheen MHH, Tan YZ, Oh LF, Wee HL, Thumboo J. Prevalence of and factors associated with primary medication non-adherence in chronic disease: A systematic review and meta-analysis. Int J Clin Pract 2019; 73:e13350. [PMID: 30941854 DOI: 10.1111/ijcp.13350] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/20/2019] [Accepted: 03/30/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Primary medication non-adherence (PMN), defined as failure to obtain newly prescribed medications, results in adverse clinical and economic outcomes. We aimed to (a) assess the prevalence of PMN in six common chronic diseases: asthma and/ or chronic obstructive pulmonary disease, depression, diabetes mellitus, hyperlipidaemia, hypertension and osteoporosis; (b) identify and categorise factors associated with PMN; (c) explore characteristics that contributed to heterogeneity between studies. METHODS We performed a systematic search in MEDLINE, Embase, Cochrane Library, CINAHL and PsycINFO. Studies published in English between January 2008 and August 2018 assessing PMN in subjects aged ≥18 years were included. We used the Cochrane risk of bias tool, Newcastle-Ottawa Scale and National Heart, Lung and Blood Institute Quality Assessment Tool to assess the quality of randomised controlled trials, cohort and cross-sectional studies, respectively. Findings were reported using the PRISMA checklist. PMN rates were pooled using a random effects model. We summarised factors associated with PMN descriptively. Subgroup analysis was performed to explore sources of heterogeneity. RESULTS We screened 3083 articles and included 33 (5 randomised controlled trials, 26 cohort and 2 cross-sectional studies, n = 539 156), of which 31 (n = 519 971) were used in meta-analysis. The pooled PMN rate was 17% (95% CI: 15%-20%). Pooled PMN rates were highest in osteoporosis (25%, 95% CI: 7%-44%) and hyperlipidaemia (25%, 95% CI: 18%-32%) and lowest in diabetes mellitus (10%, 95% CI: 7%-12%). Factors commonly associated with PMN include younger age, number of concurrent medications, practitioner specialty and higher co-payment. Type of chronic disease, age, study setting and PMN definition contributed to heterogeneity between studies (all P < 0.001). CONCLUSION Primary medication non-adherence is common among patients with chronic diseases and more needs to be done to address this issue in order to improve patient outcomes. Future PMN studies could benefit from greater standardisation to enhance comparability.
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Affiliation(s)
- McVin Hua Heng Cheen
- Department of Pharmacy, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Yan Zhi Tan
- Department of Pharmacy, Singapore General Hospital, Singapore
| | - Ling Fen Oh
- Department of Pharmacy, National University of Singapore, Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, Department of Pharmacy, National University of Singapore, Singapore
| | - Julian Thumboo
- Duke-NUS Medical School, Singapore
- Rheumatology and Immunology, Singapore General Hospital, Singapore
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Ashton RE, Tew GA, Robson WA, Saxton JM, Aning JJ. Cross-sectional study of patient-reported fatigue, physical activity and cardiovascular status in men after robotic-assisted radical prostatectomy. Support Care Cancer 2019; 27:4763-4770. [PMID: 30969369 PMCID: PMC6825227 DOI: 10.1007/s00520-019-04794-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/31/2019] [Indexed: 01/02/2023]
Abstract
Purpose Patient-reported fatigue after robotic-assisted radical prostatectomy (RARP) has not been characterised to date. Fatigue after other prostate cancer (PCa) treatments is known to impact on patient-reported quality of life. The aim of this study was to characterise fatigue, physical activity levels and cardiovascular status post-RARP. Methods Between October 2016 and March 2017, men post-RARP or on androgen deprivation therapy (ADT) were invited into the study. Participants were asked to complete the Brief Fatigue Inventory (BFI) and Stage of Change and Scottish Physical Activity Questionnaires (SPAQ) over a 2-week period. Outcome measures were patient-reported fatigue, physical activity levels and the 10-year risk of cardiovascular disease (Q-Risk). Data were analysed in SPSS. Results 96/117 (82%) men approached consented to participate; of these, 62/96 (65%) returned complete questionnaire data (RARP n = 42, ADT n = 20). All men reported fatigue with 9/42 (21%) post-RARP reporting clinically significant fatigue. Physical activity did not correlate with fatigue. On average, both groups were overweight (BMI 27.0 ± 3.9 kg/m2 and 27.8 ± 12.3 kg/m2 for RARP and ADT, respectively) and the post-RARP group had an 18.1% ± 7.4% Q-Risk2 score. Conclusions A proportion of men is at increased risk of cardiovascular disease within 10 years post-RARP and have substantial levels of fatigue; therefore, clinicians should consider including these factors when counselling patients about RARP. Additionally, men post-RARP did not meet the recommended guidelines for resistance-based exercise. Future research is needed to establish whether interventions including resistance-based exercise can improve health and fatigue levels in this population.
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Affiliation(s)
- Ruth E Ashton
- Department of Sport, Exercise and Rehabilitation, University of Northumbria at Newcastle, Newcastle upon Tyne, UK.
| | - Garry A Tew
- Department of Sport, Exercise and Rehabilitation, University of Northumbria at Newcastle, Newcastle upon Tyne, UK
| | - Wendy A Robson
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - John M Saxton
- Department of Sport, Exercise and Rehabilitation, University of Northumbria at Newcastle, Newcastle upon Tyne, UK
| | - Jonathan J Aning
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
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Systematic review of the predictors of statin adherence for the primary prevention of cardiovascular disease. PLoS One 2019; 14:e0201196. [PMID: 30653535 PMCID: PMC6336256 DOI: 10.1371/journal.pone.0201196] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/21/2018] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Previous research has shown that statin adherence for the primary prevention of CVD is lower compared to secondary prevention populations. Therefore the aim of this systematic review was to review predictors of statin adherence for the primary prevention of CVD. METHODS A systematic search of papers published between Jan 1984 and May 2017 was conducted in PubMed, PsycINFO, EMbase and CINAHL databases. A study was eligible for inclusion if; 1) it was a study of the general population or of patients with familial hypercholesterolemia, hypertension, diabetes or arthritis; 2) statins were prescribed; 3) adherence was defined and measured as the extent to which patients followed their statin regimen during the period of prescription, and 4) it was an original trial or observational study (excluding case reports). A study was subsequently excluded if 1) results were not presented separately for primary prevention; 2) it was a trial of an intervention (for example patient education). Papers were reviewed by two researchers and consensus agreed with a third. A quality assessment (QA) tool was used to formally assess each included article. To evaluate the effect of predictors, data were quantitatively and qualitatively synthesised. RESULTS In total 19 studies met the inclusion criteria and nine were evaluated as high quality using the QA tool. The proportion of patients classed as "adherent" ranged from 17.8% to 79.2%. Potential predictors of statin adherence included traditional risk factors for CVD such as age, being male, diabetes and hypertension. Income associated with adherence more strongly in men than women, and highly educated men were more likely and highly educated women less likely to be adherent. Alcohol misuse and high BMI associated with non-adherence. There was no association between polypharmacy and statin adherence. The evidence base for the effect of other lifestyle factors and health beliefs on statin adherence was limited. CONCLUSION Current evidence suggests that patients with more traditional risk factors for CVD are more likely to be adherent to statins. The implications for future research are discussed.
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Thomson K, Brouwers C, Damman OC, de Bruijne MC, Timmermans DR, Melles M. How Health Care Professionals Evaluate a Digital Intervention to Improve Medication Adherence: Qualitative Exploratory Study. JMIR Hum Factors 2018; 5:e7. [PMID: 29463494 PMCID: PMC5840481 DOI: 10.2196/humanfactors.8948] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/05/2017] [Indexed: 02/01/2023] Open
Abstract
Background Medication nonadherence poses a serious and a hard-to-tackle problem for many chronic diseases. Electronic health (eHealth) apps that foster patient engagement and shared decision making (SDM) may be a novel approach to improve medication adherence. Objective The aim of this study was to investigate the perspective of health care professionals regarding a newly developed digital app aimed to improve medication adherence. Familial hypercholesterolemia (FH) was chosen as a case example. Methods A Web-based prototype of the eHealth app—MIK—was codesigned with patients and health care professionals. After user tests with patients, we performed semistructured interviews and user tests with 12 physicians from 6 different hospitals to examine how the functionalities offered by MIK could assist physicians in their consultation and how they could be integrated into daily clinical practice. Qualitative thematic analysis was used to identify themes that covered the physicians’ evaluations. Results On the basis of the interview data, 3 themes were identified, which were (1) perceived impact on patient-physician collaboration; (2) perceived impact on the patient’s understanding and self-management regarding medication adherence; and (3) perceived impact on clinical decisions and workflow. Conclusions The eHealth app MIK seems to have the potential to improve the consultation between the patient and the physician in terms of collaboration and patient engagement. The impact of eHealth apps based on the concept of SDM for improving medication-taking behavior and clinical outcomes is yet to be evaluated. Insights will be useful for further development of eHealth apps aimed at improving self-management by means of patient engagement and SDM.
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Affiliation(s)
- Karen Thomson
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Corline Brouwers
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Danielle Rm Timmermans
- Department of Public and Occupational Health and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Marijke Melles
- Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
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Lemstra M, Nwankwo C, Bird Y, Moraros J. Primary nonadherence to chronic disease medications: a meta-analysis. Patient Prefer Adherence 2018; 12:721-731. [PMID: 29765208 PMCID: PMC5944464 DOI: 10.2147/ppa.s161151] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Medication nonadherence is a global problem that requires urgent attention. Primary nonadherence occurs when a patient consults with a medical doctor, receives a referral for medical therapy but never fills the first dispensation for the prescription medication. Nonadherence to chronic disease medications costs the USA ~$290 billion (USD) every year in avoidable health care costs. In Canada, it is estimated that 5.4% of all hospitalizations are due to medication nonadherence. OBJECTIVES The objective of this study was to quantify the extent of primary nonadherence for four of the most common chronic disease medications. The second objective was to identify factors associated with primary nonadherence to chronic disease medications. MATERIALS AND METHODS We conducted an extensive systematic literature review of eight databases with a wide range of keywords. We identified relevant articles for primary nonadherence to antihypertensives, lipid-lowering agents, hypoglycemics, and antidepressants. After further screening and assessment of methodologic quality, relevant data were extracted and analyzed using a random-effects model. RESULTS Twenty-four articles were included for our meta-analysis after full review and assessment for risk of bias. The pooled primary nonadherence rate for the four chronic disease medications was 14.6% (95% CI: 13.1%-16.2%). Primary medication nonadherence was higher for lipid-lowering medications among the four chronic disease medications assessed (20.8%; 95% CI: 16.0%-25.6%). The rates in North America (17.0%; 95% CI: 14.4%-19.5%) were twice those from Europe (8.5%; 95% CI: 7.1%-9.9%). The absence of social support (20%; 95% CI: 14.4%-26.6%) was the most common sociodemographic variable associated with chronic disease medication primary nonadherence. CONCLUSION Evidence suggests that a considerable percentage of patients do not initially fill their medications for treatable chronic diseases or conditions. This represents a major health care problem that can be successfully addressed. Efforts should be directed toward proper medication counseling, patient social support, and clinical follow-up, especially when the indications for the prescribed medication aim to provide primary prevention.
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Affiliation(s)
- Mark Lemstra
- Alliance Health Medical Clinics, Moose Jaw, Regina and Saskatoon, Saskatchewan, Canada
- Correspondence: Mark Lemstra, Alliance Health Medical Clinics, B70 500 – 1st Avenue NW, Moose Jaw, SK S6H 3M5, Canada, Email
| | - Chijioke Nwankwo
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Yelena Bird
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John Moraros
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Jörntén-Karlsson M, Pintat S, Molloy-Bland M, Berg S, Ahlqvist M. Patient-Centered Interventions to Improve Adherence to Statins: A Narrative Synthesis of Systematically Identified Studies. Drugs 2017; 76:1447-1465. [PMID: 27677773 PMCID: PMC5047948 DOI: 10.1007/s40265-016-0640-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Poor adherence to statins increases cardiovascular disease risk. We systematically identified 32 controlled studies that assessed patient-centered interventions designed to improve statin adherence. The limited number of studies and variation in study characteristics precluded strict quality criteria or meta-analysis. Cognitive education or behavioural counselling delivered face-to-face multiple times consistently improved statin adherence compared with control groups (7/8 and 3/3 studies, respectively). None of four studies using medication reminders and/or adherence feedback alone reported significantly improved statin adherence. Single interventions that improved statin adherence but were not conducted face-to-face included cognitive education in the form of genetic test results (two studies) and cognitive education via a website (one study). Similar mean adherence measures were reported for 17 intervention arms and were thus compared in a sub-analysis: 8 showed significantly improved statin adherence, but effect sizes were modest (+7 to +22 % points). In three of these studies, statin adherence improved despite already being high in the control group (82-89 vs. 57-69 % in the other studies). These three studies were the only studies in this sub-analysis to include cognitive education delivered face-to-face multiple times (plus other interventions). In summary, the most consistently effective interventions for improving adherence to statins have modest effects and are resource-intensive. Research is needed to determine whether modern communications, particularly mobile health platforms (recently shown to improve medication adherence in other chronic diseases), can replicate or even enhance the successful elements of these interventions while using less time and fewer resources.
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Affiliation(s)
| | | | - Michael Molloy-Bland
- Research Evaluation Unit, Oxford PharmaGenesis, Oxford, UK
- School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees, UK
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Banach M, Stulc T, Dent R, Toth PP. Statin non-adherence and residual cardiovascular risk: There is need for substantial improvement. Int J Cardiol 2016; 225:184-196. [PMID: 27728862 DOI: 10.1016/j.ijcard.2016.09.075] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 09/23/2016] [Indexed: 12/18/2022]
Abstract
Although statin therapy has proven to be the cornerstone for prevention and treatment of cardiovascular disease (CVD), there are many patients for whom long-term therapy remains suboptimal. The aims of this article are to review the current complex issues associated with statin use and to explore when novel treatment approaches should be considered. Statin discontinuation as well as adherence to statin therapy remain two of the greatest challenges for lipidologists. Evidence suggests that between 40 and 75% of patients discontinue their statin therapy within one year after initiation. Furthermore, whilst the reasons for persistence with statin therapy are complex, evidence shows that low-adherence to statins negatively impacts clinical outcomes and residual CV risk remains a major concern. Non-adherence or lack of persistence with long-term statin therapy in real-life may be the main cause of inadequate low density lipoprotein cholesterol lowering with statins. There is a large need for the improvement of the use of statins, which have good safety profiles and are inexpensive. On the other hand, in a non-cost-constrained environment, proprotein convertase subtilisin/kexin type 9 inhibitors should arguably be used more often in those patients in whom treatment with statins remains unsatisfactory.
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Affiliation(s)
- Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland; Healthy Aging Research Centre, Medical University of Lodz, Lodz, Poland; Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
| | - Tomas Stulc
- 3rd Department of Internal Medicine, 1st University of Medicine, Prague, Czech Republic
| | | | - Peter P Toth
- CGH Medical Center, Sterling, IL, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Wouters H, Van Dijk L, Geers HCJ, Winters NA, Van Geffen ECG, Stiggelbout AM, Bouvy ML. Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences Matter to Different Patients. PLoS One 2016; 11:e0146272. [PMID: 26808151 PMCID: PMC4726652 DOI: 10.1371/journal.pone.0146272] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/15/2015] [Indexed: 12/25/2022] Open
Abstract
Background Non-adherence to statins is substantial and is associated with numerous perceptions and experiences. However, time limits in clinical practice constrain in depth explorations of these perceptions and experiences. Objectives To propose and examine a strategy aimed at an efficient assessment of a wide array of perceptions and experiences regarding the efficacy, side effects, and practical problems of statins. Furthermore, to assess associations between this wide array of experiences and perceptions and non-adherence and to examine whether patients' 'perceived self-efficacy' moderated these associations. Methods Patients were recruited through community pharmacies. A wide array of specific patient perceptions and experiences was efficiently assessed using the electronic Tailored Medicine Inventory that allows people to skip irrelevant questions. Adherence was measured through self-report and pharmacy refill data. Results Of the two-hundred twenty-nine patients who participated (mean age 63.9, standard deviation 10.2), 40%-70% doubted the necessity of or lacked knowledge about the efficacy of statins, 20%-35% of the patients were worried about joint and muscle side effects or had experienced these, and 23% had encountered practical problems regarding information about statins, intake of tablets, the package, or the blister. Experiencing more practical problems was associated with increased unintentional non-adherence (Odds ratio 1.54, 95%CI:1.13–2.10, P < 0.01), whereas worrying about side effects was associated with increased intentional non-adherence (Odds ratio 1.90, 95%CI:1.17–3.08, P < 0.01). Higher 'perceived self-efficacy' did not moderate these associations. Conclusions Insight into patients' specific barriers with regard to appropriate statin use may reveal personal reasons for being non-adherent. The Tailored Medicine Inventory is a promising tool to devise individualized intervention strategies aimed at improving adherence by the clinician-patient alliance.
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Affiliation(s)
- Hans Wouters
- Department of Pharmacy, Unit of Pharmacotherapy and Pharmaceutical Care, Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Liset Van Dijk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Harm C. J. Geers
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Nina A. Winters
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Erica C. G. Van Geffen
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Anne M. Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcel L. Bouvy
- Division of Pharmaco-epidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
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Casula M, Tragni E, Piccinelli R, Zambon A, De Fendi L, Scotti L, Corrao G, Gambera M, Catapano AL, Filippi A. A simple informative intervention in primary care increases statin adherence. Eur J Clin Pharmacol 2015; 72:227-34. [PMID: 26563188 DOI: 10.1007/s00228-015-1975-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/30/2015] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the effectiveness of an informative intervention on general practitioners aimed at improving patients' adherence to statin therapy. METHODS In the local health unit (LHU) of Bergamo, Lombardy (Italy), each general practitioner received a synthetic scientific document on dyslipidaemia and statins and aggregated data on adherence in 2006 for his/her patients compared to the means in the LHU and in his/her working district. Furthermore, a sample of seven districts received also a table of adherence levels for single patients. Patient's level data were retrieved from the health care utilisation databases of the LHU. Adherence parameters (proportion of patients with only one prescription, medication possession ratio [MPR] and proportion of non-persistent patients) were assessed after 1 year of follow-up. RESULTS Overall, 5833 and 4788 new statin users were enrolled before and after the intervention, respectively. The percentage of patients with only one prescription decreased from 28.0 to 23.9 % (p < 0.001). MPR increased from 70.3 to 76.0 % (p < 0.001), and proportion of patients with MPR ≥ 80 % increased from 45.4 to 56.4 % (p < 0.001). The persistence also showed an improvement, both in terms of decreasing proportion of non-persistent (from 51.9 to 41.4 %, p < 0.001) and of increasing duration of continued therapy (from 235 to 264 mean days of persistent therapy, p < 0.001). There were not significant differences between the two types of intervention. CONCLUSIONS This intervention resulted in an overall improvement of the short-term adherence to therapy. This tool can be replicated in other local contexts and with other chronic therapies.
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Affiliation(s)
- Manuela Casula
- Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133, Milan, Italy.
| | - Elena Tragni
- Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133, Milan, Italy
| | - Rossana Piccinelli
- Local Pharmaceutical Service, LHU of Bergamo, via Gallicciolli 4, 24121, Bergamo, Italy
| | - Antonella Zambon
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126, Milan, Italy
| | - Luisa De Fendi
- Local Pharmaceutical Service, LHU of Bergamo, via Gallicciolli 4, 24121, Bergamo, Italy
| | - Lorenza Scotti
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126, Milan, Italy
| | - Giovanni Corrao
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Via Bicocca degli Arcimboldi 8, 20126, Milan, Italy
| | - Marco Gambera
- Local Pharmaceutical Service, LHU of Bergamo, via Gallicciolli 4, 24121, Bergamo, Italy
| | - Alberico Luigi Catapano
- Epidemiology and Preventive Pharmacology Centre (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Via Balzaretti 9, 20133, Milan, Italy.,IRCCS MultiMedica, via Milanese 300, 20099 Sesto S. Giovanni, Milan, Italy
| | - Alessandro Filippi
- Italian Society of General Medicine (SIMG), Via del Pignoncino 9-11, 50142, Florence, Italy
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Kountz DS, Kofman E. Improving Medication Routines and Adherence in Hypertensive African Americans: Finding the Needle in the Haystack. J Clin Hypertens (Greenwich) 2015; 17:673-4. [DOI: 10.1111/jch.12564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Turin A, Pandit J, Stone NJ. Statins and Nonadherence. J Cardiovasc Pharmacol Ther 2015; 20:447-56. [DOI: 10.1177/1074248415578170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 02/23/2015] [Indexed: 12/18/2022]
Abstract
Statin nonadherence is a major challenge to optimal management. Patients nonadherent to statin therapy do not receive the expected benefit relative to the degree of low-density lipoprotein cholesterol (LDL-C) lowering obtained. This is important because new evidence guidelines recommend statins as the first-line therapy for those in high-risk groups (secondary prevention, patients with diabetes 40-75 years of age, and LDL-C ≥ 190 mg/dL) and in selected primary prevention patients. Statin assignment in the latter group occurs only in those with an estimated ≥7.5% 10-year atherosclerotic cardiovascular disease risk after shared decision making in a clinician–patient risk discussion. However, in numerous studies, statin nonadherence shows little or no benefit in reducing cardiovascular events or mortality compared to placebo, effectively negating the risk reduction expected from statin use and concomitantly increasing the total cost of health care. The causes and solutions for nonadherence are multifactorial and include patient, clinician, and health system factors. We believe that a clinician–patient partnership that facilitates patients’ understanding of the potential for optimal benefit with the least adverse effects is an important first step toward improving adherence. A transtheoretical model of stages of behavior change helps clinicians address many of the common factors limiting adherence to statins. We conclude with a teaching tool emphasizing a structured approach to statin therapy with patient-centered risk discussions.
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Affiliation(s)
- Alexander Turin
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Jay Pandit
- Department of Cardiology, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
| | - Neil J. Stone
- Department of Cardiology, Bluhm Cardiovascular Institute, Northwestern University, Chicago, IL, USA
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Chee YJ, Chan HHV, Tan NC. Understanding patients' perspective of statin therapy: can we design a better approach to the management of dyslipidaemia? A literature review. Singapore Med J 2014; 55:416-21. [PMID: 25189302 PMCID: PMC4294090 DOI: 10.11622/smedj.2014099] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Dyslipidaemia leads to atherosclerosis and is a major risk factor for cardiovascular diseases. In clinical trials, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, or statins, have been shown to effectively reduce dyslipidaemia. Despite the availability and accessibility of statins, myocardial infarctions and cerebrovascular accidents remain among the top causes of mortality in developed countries, including Singapore. This enigma could be attributed to suboptimal adherence to statin therapy. The present literature review aimed to evaluate patients' perceptions of statin therapy. METHODS We searched PubMed and other databases for articles published in English from October 1991 to May 2012 containing keywords such as 'patient', 'views', 'perceptions', 'adherence', 'statin' and 'dyslipidaemia'. Of the 122 eligible studies retrieved, 58 were reviewed. The findings were categorised and framed in accordance with the Health Belief Model. RESULTS Patients with dyslipidaemia appeared to underestimate their susceptibility to dyslipidaemia-related complications, partly due to their demographic profiles. Failure to appreciate the severity of potential complications was a major hindrance toward adherence to statin therapy. Other factors that affected a patient's adherence included lack of perceived benefits, perceived side effects, the cost of statins, poor physician-patient relationship, and overestimation of the effectiveness of diet control as a treatment modality. CONCLUSION Existing evidence suggests that the cause of poor adherence to statin therapy is multifactorial. The use of the Health Belief Model to present the results of our literature review provides a systematic framework that could be used to design a patient-centric approach for enhancing adherence to statin therapy.
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Affiliation(s)
- Ying Jie Chee
- Department of General Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
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Fontana M, Asaria P, Moraldo M, Finegold J, Hassanally K, Manisty CH, Francis DP. Patient-accessible tool for shared decision making in cardiovascular primary prevention: balancing longevity benefits against medication disutility. Circulation 2014; 129:2539-2546. [PMID: 24744274 DOI: 10.1161/circulationaha.113.007595] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary prevention guidelines focus on risk, often assuming negligible aversion to medication, yet most patients discontinue primary prevention statins within 3 years. We quantify real-world distribution of medication disutility and separately calculate the average utilities for a range of risk strata. METHOD AND RESULTS We randomly sampled 360 members of the general public in London. Medication aversion was quantified as the gain in lifespan required by each individual to offset the inconvenience (disutility) of taking an idealized daily preventative tablet. In parallel, we constructed tables of expected gain in lifespan (utility) from initiating statin therapy for each age group, sex, and cardiovascular risk profile in the population. This allowed comparison of the widths of the distributions of medication disutility and of group-average expectation of longevity gain. Observed medication disutility ranged from 1 day to >10 years of life being required by subjects (median, 6 months; interquartile range, 1-36 months) to make daily preventative therapy worthwhile. Average expected longevity benefit from statins at ages ≥50 years ranges from 3.6 months (low-risk women) to 24.3 months (high-risk men). CONCLUSION We can no longer assume that medication disutility is almost zero. Over one-quarter of subjects had disutility exceeding the group-average longevity gain from statins expected even for the highest-risk (ie, highest-gain) group. Future primary prevention studies might explore medication disutility in larger populations. Patients may differ more in disutility than in prospectively definable utility (which provides only group-average estimates). Consultations could be enriched by assessing disutility and exploring its reasons.
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Affiliation(s)
- Marianna Fontana
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Perviz Asaria
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Michela Moraldo
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Judith Finegold
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Khalil Hassanally
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Charlotte H Manisty
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Darrel P Francis
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
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Duffy D, Kelly E, Trang A, Whellan D, Mills G. Aspirin for cardioprotection and strategies to improve patient adherence. Postgrad Med 2014; 126:18-28. [PMID: 24393748 DOI: 10.3810/pgm.2014.01.2721] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in North America. Aspirin therapy has proven clinical effectiveness in the prevention and treatment of CVD and is one of the most widely used drugs nationwide. However, despite the medication's popularity and utility, adherence to a proper aspirin regimen is suboptimal, resulting in adverse health outcomes and increased health care costs. Our review outlines current knowledge on aspirin therapy adherence, causes of nonadherence, and strategies available to increase adherence to aspirin and medications in general. We demonstrate that, indeed, aspirin adherence rates are suboptimal, ranging from 72% to 92%, and that a combination of patient- and medication-related factors contribute to nonadherence. A multidimensional approach involving patient education and medication innovations to reduce aspirin side effects is imperative to improving rates of aspirin therapy adherence.
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Affiliation(s)
- Danielle Duffy
- Assistant Professor, Division of Cardiology, Jefferson Medical College.
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Maningat P, Gordon BR, Breslow JL. How do we improve patient compliance and adherence to long-term statin therapy? Curr Atheroscler Rep 2013; 15:291. [PMID: 23225173 DOI: 10.1007/s11883-012-0291-7] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Statins are highly effective drugs prescribed to millions of people to lower LDL-cholesterol and decrease cardiovascular risk. The benefits of statin therapy seen in randomized clinical trials will only be replicated in real-life if patients adhere to the prescribed treatment regimen. But, about half of patients discontinue statin therapy within the first year, and adherence decreases with time. Patient, physician and healthcare system-related factors play a role in this problem. Recent studies have focused more on the patients' perspectives on non-adherence. Adverse events are cited as the most common cause of statin discontinuation; thus, the healthcare provider must be willing to ally and dialogue with patients to address concerns and assess the risks and benefits of continued statin therapy.
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Evaluation of Cardiovascular Morbidity Associated with Adherence to Atorvastatin Therapy. Am J Ther 2012; 19:24-32. [DOI: 10.1097/mjt.0b013e3181ee707e] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Pérez A, González Blanco C, Hernández-Presa MÁ, Chaves J. [Therapeutic approach to dyslipidemia and goal achievement in a Spanish population with type 2 diabetes without cardiovascular disease]. ACTA ACUST UNITED AC 2011; 58:283-90. [PMID: 21641286 DOI: 10.1016/j.endonu.2011.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 03/28/2011] [Accepted: 03/28/2011] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the therapeutic approach and lipid goal achievement in a spanish diabetic population at high cardiovascular risk. SUBJECTS AND METHODS A multicenter, descriptive, cross-sectional study consecutively recruited the first 10 patients who attended the primary care office and had been seen in the 12 months prior to the study visit. Inclusion criteria were type 2 diabetes without cardiovascular disease, LDL cholesterol levels ≤160mg/dL, triglyceride levels ≤600mg/dL, and at least one of the following: retinopathy, albuminuria, current smoking, or hypertension. RESULTS A total of 2412 patients were evaluated (aged 61.3±8.3 years, 46.8% women, diabetes duration 8.6±7.4 years). As compared to the previous visit (8.1±5 months before), the proportion of patients who achieved LDL-C levels <100mg/dL (22.7% vs 28.6%), non-HDL-C levels <130mg/dL (27.7% vs 33.8%) and both goals (17.6% vs 22.1%) significantly increased at the time of assessment. Statins were the most widely prescribed lipid-lowering drugs (65.5%) and the lipid-lowering drug was changed from the previous visit in 38.7% of patients, drug dosage was increased in 17.3%, and another drug was added in 5%. CONCLUSION Use of more potent statins and higher statin doses were the most commonly used therapeutic strategies for improving control of dyslipidemia in patients with type 2 diabetes, but these changes were clearly inadequate to achieve lipid goals in most patients with type 2 diabetes.
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Affiliation(s)
- Antonio Pérez
- Servicio de Endocrinología y Nutrición, Hospital de la Santa Creu i Sant Pau, Barcelona, España.
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Van de Steeg-van Gompel CHPA, Wensing M, De Smet PAGM. Implementation of patient education at first and second dispensing of statins in Dutch community pharmacies: the sequel of a cluster randomized trial. BMC Health Serv Res 2011; 11:313. [PMID: 22087850 PMCID: PMC3258215 DOI: 10.1186/1472-6963-11-313] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 11/16/2011] [Indexed: 11/10/2022] Open
Abstract
Background As a result of the previous part of this trial, many patients with cardiovascular disease were expected to receive a statin for the first time. In order to provide these patients with comprehensive information on statins, as recommended by professional guidance, education at first and second dispensing of statins had to be implemented. This study was designed to assess the effectiveness of an intensive implementation program targeted at pharmacy project assistants on the frequency of providing education at first dispensing (EAFD) and education at second dispensing (EASD) of statins in community pharmacies. Methods The participating community pharmacies were clustered on the basis of local collaboration, were numbered by a research assistant and subsequently an independent statistician performed a block randomization, in which the cluster size (number of pharmacies in each cluster) was balanced. The pharmacies in the control group received a written manual on the implementation of EAFD and EASD; the pharmacies in the intervention group received intensive support for the implementation. The impact of the intensive implementation program on the implementation process and on the primary outcomes was examined in a random coefficient logistic regression model, which took into account that patients were grouped within pharmacy clusters. Results Of the 37 pharmacies in the intervention group, 17 pharmacies (50%) provided EAFD and 12 pharmacies (35.3%) provided EASD compared to 14 pharmacies (45.2%, P = 0.715) and 12 pharmacies (38.7%, P = 0.899), respectively, of the 34 pharmacies in the control group. In the intervention group a total of 72 of 469 new statin users (15.4%) received education and 49 of 393 patients with a second statin prescription (12.5%) compared to 78 of 402 new users (19.4%, P = 0.944) and 35 of 342 patients with a second prescription (10.2%, P = 0.579) in the control group. Conclusion The intensive implementation program did not increase the frequency of providing EAFD and EASD of statins in community pharmacies. Trial Registration clinicaltrials.gov NCT00509717
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Affiliation(s)
- Caroline H P A Van de Steeg-van Gompel
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Turner BJ, Hollenbeak CS, Weiner M, Tang SSK. A retrospective cohort study of the potency of lipid-lowering therapy and race-gender differences in LDL cholesterol control. BMC Cardiovasc Disord 2011; 11:58. [PMID: 21961563 PMCID: PMC3197552 DOI: 10.1186/1471-2261-11-58] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 09/30/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reasons for race and gender differences in controlling elevated low density lipoprotein (LDL) cholesterol may be related to variations in prescribed lipid-lowering therapy. We examined the effect of lipid-lowering drug treatment and potency on time until LDL control for black and white women and men with a baseline elevated LDL. METHODS We studied 3,484 older hypertensive patients with dyslipidemia in 6 primary care practices over a 4-year timeframe. Potency of lipid-lowering drugs calculated for each treated day and summed to assess total potency for at least 6 and up to 24 months. Cox models of time to LDL control within two years and logistic regression models of control within 6 months by race-gender adjust for: demographics, clinical, health care delivery, primary/specialty care, LDL measurement, and drug potency. RESULTS Time to LDL control decreased as lipid-lowering drug potency increased (P < 0.001). Black women (N = 1,440) received the highest potency therapy (P < 0.001) yet were less likely to achieve LDL control than white men (N = 717) (fully adjusted hazard ratio [HR] 0.66 [95% CI 0.56-0.78]). Black men (N = 666) and white women (N = 661) also had lower adjusted HRs of LDL control (0.82 [95% CI 0.69, 0.98] and 0.75 [95% CI 0.64-0.88], respectively) than white men. Logistic regression models of LDL control by 6 months and other sensitivity models affirmed these results. CONCLUSIONS Black women and, to a lesser extent, black men and white women were less likely to achieve LDL control than white men after accounting for lipid-lowering drug potency as well as diverse patient and provider factors. Future work should focus on the contributions of medication adherence and response to treatment to these clinically important differences.
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Affiliation(s)
- Barbara J Turner
- Division of General Internal Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA.
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Drozda J, Messer JV, Spertus J, Abramowitz B, Alexander K, Beam CT, Bonow RO, Burkiewicz JS, Crouch M, Goff DC, Hellman R, James T, King ML, Machado EA, Ortiz E, O'Toole M, Persell SD, Pines JM, Rybicki FJ, Sadwin LB, Sikkema JD, Smith PK, Torcson PJ, Wong JB. ACCF/AHA/AMA–PCPI 2011 Performance Measures for Adults With Coronary Artery Disease and Hypertension. Circulation 2011; 124:248-70. [DOI: 10.1161/cir.0b013e31821d9ef2] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Joseph Drozda
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Joseph V. Messer
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - John Spertus
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | - Karen Alexander
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Craig T. Beam
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Robert O. Bonow
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Jill S. Burkiewicz
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Michael Crouch
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - David C. Goff
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Richard Hellman
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | - Marjorie L. King
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Edison A. Machado
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | | | | | - Jesse M. Pines
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Frank J. Rybicki
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | | | - Joanna D. Sikkema
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Peter K. Smith
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
| | - Patrick J. Torcson
- ACCF/AHA Representative. Recused from voting on Measures 3 and 4. American Geriatrics Society Representative. American Heart Association Consumer Council Representative. American Society of Health-System Pharmacists Representative. American Academy of Family Physicians Representative. ACCF/AHA Task Force on Performance Measures Liaison. American Association of Clinical Endocrinologists Representative. American Association of Cardiovascular and Pulmonary Rehabilitation Representative. Involved in
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Drozda J, Messer JV, Spertus J, Abramowitz B, Alexander K, Beam CT, Bonow RO, Burkiewicz JS, Crouch M, Goff DC, Hellman R, James T, King ML, Machado EA, Ortiz E, O'Toole M, Persell SD, Pines JM, Rybicki FJ, Sadwin LB, Sikkema JD, Smith PK, Torcson PJ, Wong JB. ACCF/AHA/AMA-PCPI 2011 performance measures for adults with coronary artery disease and hypertension: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association-Physician Consortium for Performance Improvement. J Am Coll Cardiol 2011; 58:316-36. [PMID: 21676572 DOI: 10.1016/j.jacc.2011.05.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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van Geffen ECG, Philbert D, van Boheemen C, van Dijk L, Bos MB, Bouvy ML. Patients' satisfaction with information and experiences with counseling on cardiovascular medication received at the pharmacy. PATIENT EDUCATION AND COUNSELING 2011; 83:303-309. [PMID: 21550196 DOI: 10.1016/j.pec.2011.04.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 03/31/2011] [Accepted: 04/04/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To assess the extent to which patients feel they have received enough information on cardiovascular drugs and experienced counseling at the pharmacy. In addition, to identify factors that are predictors for patient satisfaction with the information received. METHODS Fifteen community pharmacies participated. New and chronic users of cardiovascular medication received a questionnaire containing sociodemographic and health questions, a measure of satisfaction with information received (SIMS), beliefs about medication (BMQ), and frequency of pharmacy counseling. RESULTS Of the 578 respondents, 335 (58%) indicated to be unsatisfied with the information received on 3 or more SIMS items. Patients' age, beliefs about medication, duration of cardiovascular treatment and use of antithrombotics predicted patients' satisfaction with information received. Two-thirds of patients reported 'never' to have experienced 5 of 8 counseling activities at the pharmacy. CONCLUSIONS A considerable proportion of patients are unsatisfied with the information received on cardiovascular medication. The majority of patients have only received a limited scope of medication counseling at the pharmacy. PRACTICE IMPLICATIONS Information and counseling should be tailored to patients' needs and concerns about cardiovascular medication and the experience patients already have with treatment. Pharmacists could enhance their role in supporting patients using cardiovascular medication.
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Affiliation(s)
- Erica C G van Geffen
- Division Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
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Paraskevas KI, Mikhailidis DP, Veith FJ. Optimal statin type and dosage for vascular patients. J Vasc Surg 2011; 53:837-44. [PMID: 21215572 DOI: 10.1016/j.jvs.2010.10.114] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 10/14/2010] [Accepted: 10/23/2010] [Indexed: 12/29/2022]
Abstract
Statins are an essential component of the management of patients suffering from vascular diseases. As there is neither any consensus nor any guidelines regarding this issue, we aimed to define the optimal statin type and dosage for these patients. MEDLINE was searched for studies comparing different statin types and dosages for vascular patients. In the absence of adverse effects, rosuvastatin or atorvastatin ≥ 20 mg/d is the optimal statin type and dosage for vascular patients. The management of statin-induced adverse events and the options for statin-intolerant patients are also discussed. Routine statin treatment is associated with several beneficial effects in vascular patients whether managed conservatively or undergoing open vascular surgery/endovascular interventions. If possible, statins should not be discontinued before open or endovascular procedures and treatment should be resumed as soon as possible. Future studies should evaluate the effects of an increased statin loading dose prior to vascular procedures.
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Kirkegaard P, Edwards AGK, Hansen B, Hansen MD, Jensen MSA, Lauritzen T, Risoer MB, Thomsen JL. The RISAP-study: a complex intervention in risk communication and shared decision-making in general practice. BMC FAMILY PRACTICE 2010; 11:70. [PMID: 20860820 PMCID: PMC2954954 DOI: 10.1186/1471-2296-11-70] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 09/22/2010] [Indexed: 01/08/2023]
Abstract
Background General practitioners (GPs) and patients find it difficult to talk about risk of future disease, especially when patients have asymptomatic conditions, and treatment options are unlikely to cause immediate perceptible improvements in well-being. Further studies in risk communication training are needed. Aim:1) to systematically develop, describe and evaluate a complex intervention comprising a training programme for GPs in risk communication and shared decision-making, 2) to evaluate the effect of the training programme on real-life consultations between GPs and patients with high cholesterol levels, and 3) to evaluate patients' reactions during and after the consultations. Methods/Design The effect of the complex intervention, based around a training programme, will be evaluated in a cluster-randomised controlled trial with an intervention group and an active control group with 40 GPs and 280 patients in each group. The GPs will receive a questionnaire at baseline and after 6 months about attitudes towards risk communication and cholesterol-reducing medication. After each consultation with a participating high cholesterol-patient, the GPs will complete a questionnaire about decision satisfaction (Provider Decision Process Assessment Instrument). The patients will receive a questionnaire at baseline and after 3 and 6 months. It includes questions about adherence to chosen treatment (Morisky Compliance Scale), self-rated health (SF-12), enablement (Patient Enablement Instrument), and risk communication and decision-making effectiveness (COMRADE Scale). Prescriptions, contacts to the health services, and cholesterol level will be drawn from the registers. In each group, 12 consultations will be observed and tape-recorded. The patients from these 24 consultations will be interviewed immediately after the consultation and re-interviewed after 6 months. Eight purposefully selected GPs from the intervention group will be interviewed in a focus group 6 months after participation in the training programme. The process and context of the RISAP-study will be investigated in detail using an action research approach, in order to analyse adaptation of the intervention model to the specific context. Discussion This study aims at providing GPs and patients with a firm basis for active deliberation about preventive treatment options, with a view to optimising adherence to chosen treatment. Trial registration ClinicalTrials.gov Protocol Registration System NCT01187056
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Affiliation(s)
- Pia Kirkegaard
- School of Public Health, Dept, of General Practice, Aarhus University, Bartholins Alle 2, DK-8000 Aarhus C, Denmark.
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Abstract
Abstract Recent guidelines recommend strict goals for low-density lipoprotein cholesterol (LDL-C) (1.8-2.6 mmol/L; 70-100 mg/dL). However, these goals are not always met and many primary and secondary prevention patients are not optimally controlled. Both the under-prescription of lipid-lowering medication and lack of adherence to prescribed medications could account for this situation. In this issue of the journal, two studies evaluated the under-treatment of hypercholesterolemia in European countries, as well as patient/physician characteristics that are related to poor control of LDL-C. This editorial considers the implications of these findings. While we have come far in recent years in terms of treating hypercholesterolemia, we still have considerable room for improvement and progress towards evidence-based clinical practice.
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