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Bardoczi JB, Brunner L, Spinewine A, Rodondi N, Aubert CE. Older Adult Attitudes toward Deprescribing Statins in Primary Cardiovascular Prevention Versus General Medications. Gerontol Geriatr Med 2024; 10:23337214241245918. [PMID: 38628165 PMCID: PMC11020750 DOI: 10.1177/23337214241245918] [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: 10/06/2023] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Background: There is little evidence for statins for primary cardiovascular prevention in older adults. Consequently, it is important to assess patient attitudes toward the use of statins, which might differ from attitudes toward other medications. We aimed to describe older patient attitudes toward deprescribing statins versus general medications. Methods: We conducted a survey using the revised Patients' Attitudes Toward Deprescribing questionnaire in its original version and adapted to statin use in adults ≥65 years taking a statin for primary prevention. Results: Among the 47 participants (mean age 74.6 years), 42 (89%) were satisfied with their current therapy, but still willing to stop ≥1 of their medications upon their doctor's advice. About 68% (N = 32) were satisfied with their statin therapy, while 83% (N = 39) would accept to consider deprescribing. Twenty-six (55%) participants were concerned about missing future benefits when stopping their general medications and 17 (36%) when stopping their statin. Eight (17%) participants believed they were experiencing side effects of statins and twice as many for general medication (38%, N = 18). Conclusion: Our study provides insight about differences and similarities in patient attitudes toward deprescribing general medications and statins in primary prevention. This information could support patient-centered conversations and shared-decision making about deprescribing.
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Affiliation(s)
| | | | - Anne Spinewine
- Louvain Drug Research Institute, Université catholique de Louvain, Brussels, Belgium
- Centre Hospitalier Universitaire (CHU) UCL Namur, Yvoir, Belgium
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Kayıkcioglu M, Başaran Ö, Doğan V, Mert KU, Mert GÖ, Özdemir İH, Rencüzoğulları İ, Karadeniz FÖ, Tekinalp M, Aşkın L, Demirelli S, Gencer E, Bekar L, Aktaş M, Resulzade MM, Kalçık M, Aksan G, Cinier G, Akay KH, Pekel N, Utku Şenol, Demir V, İnci S, Derviş E, Özlek B, Özlek E, Çelik O, Çil C, Biteker M. Misperceptions and management of LDL-cholesterol in secondary prevention of patients with familial hypercholesterolemia in cardiology practice: Real-life evidence from the EPHESUS registry. J Clin Lipidol 2023; 17:732-742. [PMID: 38072583 DOI: 10.1016/j.jacl.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) is a common inherited disease, leading to premature atherosclerotic cardiovascular disease (ASCVD) due to elevated low-density lipoprotein cholesterol (LDL-C) levels. Achieving LDL-C goals is extremely important for preventing the complications of this fatal disease. We evaluated the management of FH patients with ASCVD in cardiology practice. METHODS We analyzed patients with ASCVD from the nationwide EPHESUS registry, which was conducted in 40 cardiology outpatient clinics, and compared those with and without FH. RESULTS Of the 1482 consecutively enrolled patients with ASCVD, 618 (41.7%) had FH, among which 455 were categorized as 'Possible FH' and 163 as 'Probable or Definite FH'. Proposed LDL-C goals were not attained in more than 90% of the patients with FH. The proportion of those on statin therapy was 77% for possible and 91% for probable or definite FH, whereas 34.2 % and 59.4% were in use of high-intensity statins, respectively. None of the patients were on PCSK-9 inhibitors, and only 2 used ezetimibe. Adverse media coverage was the most common cause of statin discontinuation (32.5% in 'possible FH' and 45.7% in 'probable/definite FH'). The negative impact of media in the decision to stop lipid lowering therapy (LLT) was increasing with education level. CONCLUSIONS In real life most of the FH patients with ASCVD are undertreated in cardiology practice regarding statin dosing and combined LLT. Drug discontinuation rates are notably high and are mostly media-related, and side effects very rarely cause cessation of LLT. Urgent measures are needed to increase the awareness of FH among healthcare providers and patients and to develop improved treatment strategies aimed at preventing the complications of FH.
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Affiliation(s)
- Meral Kayıkcioglu
- Department of Cardiology (Dr Kayıkcioglu), Ege University Faculty of Medicine, İzmir, Turkey.
| | - Özcan Başaran
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Volkan Doğan
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology (Dr Mert), Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Gurbet Özge Mert
- Department of Cardiology (Dr Mert), Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | | | - İbrahim Rencüzoğulları
- Department of Cardiology (Dr Rencüzoğulları), Kafkas University Faculty of Medicine, Kars, Turkey
| | - Fatma Özpamuk Karadeniz
- Department of Cardiology (Dr Karadeniz), Karamanoglu Mehmetbey University Faculty of Medicine, Karaman, Turkey
| | - Mehmet Tekinalp
- Department of Cardiology (Dr Tekinalp), Necip Fazıl State Hospital, Kahramanmaras, Turkey
| | - Lütfü Aşkın
- Department of Cardiology (Dr Aşkın), Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | - Selami Demirelli
- Department of Cardiology (Dr Demirelli), Kayseri City Hospital, Kayseri, Turkey
| | - Erkan Gencer
- Department of Cardiology (Dr Gencer), Şanlıurfa Mehmet Akif İnan Education and Research Hospital, Şanlıurfa, Turkey
| | - Lütfü Bekar
- Department of Cardiology (Drs Bekar, Kalçık), Hitit University Faculty of Medicine, Çorum, Turkey
| | - Müjdat Aktaş
- Department of Cardiology (Dr Aktaş), Arnavutköy State Hospital, Istanbul, Turkey
| | | | - Macit Kalçık
- Department of Cardiology (Drs Bekar, Kalçık), Hitit University Faculty of Medicine, Çorum, Turkey
| | - Gökhan Aksan
- Department of Cardiology (Dr Aksan), Samsun Education and Research Hospital, Samsun, Turkey
| | - Göksel Cinier
- Department of Cardiology (Dr Cinier), Siyami Ersek Education and Research Hsopital, Istanbul, Turkey
| | - Kadriye Halli Akay
- Department of Cardiology (Dr Akay), Kocaeli State Hospital, Kocaeli, Turkey
| | - Nihat Pekel
- Department of Cardiology (Dr Pekel), Tekden Private Hospital Denizli, Turkey
| | - Utku Şenol
- Department of Cardiology (Dr Utku Şenol), Eskişehir Acıbadem Hospital, Eskişehir, Turkey
| | - Vahit Demir
- Department of Cardiology (Dr Demir), Yozgat City Hospital, Yozgat, Turkey
| | - Sinan İnci
- Department of Cardiology (Dr İnci), Aksaray University Faculty of Medicine, Aksaray
| | - Emir Derviş
- Department of Cardiology (Dr Derviş), Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Bülent Özlek
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology (Dr Çil), Medlife Medical Center, Muğla, Turkey
| | - Murat Biteker
- Department of Cardiology (Dr Biteker), Private Fethiye Lokman Hekim Hospital, Mugla, Turkey
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Jeeyavudeen MS, Pappachan JM, Arunagirinathan G. Statin-related Muscle Toxicity: An Evidence-based Review. TOUCHREVIEWS IN ENDOCRINOLOGY 2022; 18:89-95. [PMID: 36694885 PMCID: PMC9835810 DOI: 10.17925/ee.2022.18.2.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/12/2022] [Indexed: 12/12/2022]
Abstract
The efficacy of statins in the primary and secondary prevention of cardiovascular disease has been proven beyond doubt. The number needed to treat to prevent one cardiovascular event is 1 in 30 over 10 years, and the number needed to treat for secondary prevention is much lower. However, a recent study demonstrated that only 68% of eligible patients are on statin therapy. Moreover, there seems to be a reluctance to escalate statin doses due to the fear of adverse effects. The adverse effects that worries patients and their physicians most frequently are those related to muscular symptoms. N-of-1 trial evidence suggests that muscular symptoms attributed to statins are often caused by the nocebo effect. This article aims to provide a structured, evidence-based approach to suspected statin-related muscle toxicity.
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Affiliation(s)
| | - Joseph M Pappachan
- Lancashire Teaching Hospitals NHS Trust, Lancashire, UK,Manchester Metropolitan University, Manchester, UK
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Bremer S, Henjum S, Sæther EM, Hovland R. Drug-related problems and satisfaction among patients receiving pharmacist-led consultations at the initiation of cardiovascular drugs. Res Social Adm Pharm 2022; 18:3939-3947. [PMID: 35750567 DOI: 10.1016/j.sapharm.2022.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/30/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Drug-related problems (DRPs) lead to substantial morbidity and mortality and increase healthcare costs. Several interventions have been developed to reduce DRPs and improve the outcome of drug therapy. OBJECTIVE To investigate DRPs identified through a pharmacist-led intervention and to assess patient satisfaction with the intervention. METHODS Patients received two pharmacist consultations 1-2 weeks and 3-5 weeks after collecting a new cardiovascular medicine. Information about patient characteristics, beliefs about medicines (BMQ), DRPs, and patient evaluations were collected using questionnaires. RESULTS Pharmacists identified DRPs among 52.4% and 43.1% of the 633 patients at consultation 1 and 2, respectively. Of the DRPs reported in consultation 1, 43.7% were solved at consultation 2. Among patients with side effects, patients who received advice on managing these in consultation 1 where more likely to have solved problems at consultation 2 (61.2% vs. 42.6%, p = 0.008). Female gender, high BMQ concern and the number of new medicines were associated with DRPs. Patients were highly satisfied with the intervention. Predictors of satisfaction were female gender, older age, higher BMQ necessity, face-to-face consultations, longer duration of consultation 1, and solved problems in consultation 2. CONCLUSIONS The results indicate that the pharmacist-led follow-up intervention can aid early identification and solving of DRPs in patients prescribed new cardiovascular drugs. Knowledge of factors associated with DRPs and patients' satisfaction may allow further improvement of the intervention.
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Affiliation(s)
- Sara Bremer
- Apokus, National Centre for Development of Pharmacy Practice, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway.
| | - Solveig Henjum
- Norwegian Pharmacy Association, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway
| | | | - Ragnar Hovland
- Apokus, National Centre for Development of Pharmacy Practice, P.O. Box 5070 Majorstuen, 0301, Oslo, Norway
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Amadid H, Rønn PF, Bekker-Nielsen Dunbar M, Knudsen JS, Carstensen B, Persson F, Jørgensen ME. A large remaining potential in lipid-lowering drug treatment in the type 2 diabetes population: A Danish nationwide cohort study. Diabetes Obes Metab 2021; 23:2354-2363. [PMID: 34189831 DOI: 10.1111/dom.14478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 06/16/2021] [Accepted: 06/27/2021] [Indexed: 11/26/2022]
Abstract
AIM To assess lipid-lowering drug (LLD) use patterns during 1996-2017 and examine lipid levels in relation to the use of LLDs and prevalent atherosclerotic cardiovascular disease (ASCVD). METHODS Using a nationwide diabetes register, 404 389 individuals with type 2 diabetes living in Denmark during 1996-2017 were identified. Individuals were followed from 1 January 1996 or date of type 2 diabetes diagnosis until date of emigration, death or 1 January 2017. Redemptions of prescribed LLDs were ascertained from the nationwide Register of Medicinal Products Statistics. Data on lipid levels were sourced from the National Laboratory Database since 2010. LLD coverage was calculated at any given time based on the redeemed amount and dose. Trends in lipid levels were estimated using an additive mixed-effect model. Low-density lipoprotein cholesterol (LDL-C) goal attainment was assessed based on recommended targets by the 2011, 2016 and 2019 guidelines for management of dyslipidaemias. RESULTS LLD use has decreased since 2012 and only 55% of those with type 2 diabetes were LLD users in 2017. A decline in levels of total cholesterol and LDL-C, and an increase in triglycerides, was observed during 2010-2017. Annual mean levels of LDL-C were lower among LLD users compared with non-users (in 2017: 1.84 vs. 2.57 mmol/L). A greater fraction of LLD users achieved the LDL-C goal of less than 1.8 mmol/L compared with non-users (in 2017: 51.7% and 19%, respectively). Among LLD users with prevalent ASCVD, 26.9% and 55% had, as recommended by current 2019 European guidelines, an LDL-C level of less than 1.4 mmol/L and less than 1.8 mmol/L, respectively, in 2017. CONCLUSIONS LLD use and LDL-C levels are far from optimal in the Danish type 2 diabetes population and improvement in LLD use could reduce ASCVD events.
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Affiliation(s)
- Hanan Amadid
- Department of Epidemilogical Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Pernille F Rønn
- Department of Epidemilogical Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | | | - Jakob S Knudsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bendix Carstensen
- Department of Epidemilogical Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Frederik Persson
- Department of Epidemilogical Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Marit E Jørgensen
- Department of Epidemilogical Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
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6
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Crutzen S, Abou J, Smits SE, Baas G, Hugtenburg JG, Heringa M, Denig P, Taxis K. Older people's attitudes towards deprescribing cardiometabolic medication. BMC Geriatr 2021; 21:366. [PMID: 34134649 PMCID: PMC8207766 DOI: 10.1186/s12877-021-02249-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overtreatment with cardiometabolic medication in older patients can lead to major adverse events. Timely deprescribing of these medications is therefore essential. Self-reported willingness to stop medication is usually high among older people, still overtreatment with cardiometabolic medication is common and deprescribing is rarely initiated. An important barrier for deprescribing reported by general practitioners is the patients' unwillingness to stop the medication. More insights are needed into the influence of patients' characteristics on their attitudes towards deprescribing and differences in these attitudes between cardiometabolic medication groups. METHODS A survey in older people using cardiometabolic medication using the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was performed. Participants completed the general rPATD and an adapted version for four medication groups. Linear and ordinal logistic regression were used to assess the influence of age, sex, therapeutic area and number of medications used on the patients' general attitudes towards deprescribing. Univariate analysis was used to compare differences in deprescribing attitudes towards sulfonylureas, insulins, antihypertensive medication and statins. RESULTS Overall, 314 out of 1143 invited participants completed the survey (median age 76 years, 54% female). Most participants (80%) were satisfied with their medication and willing to stop medications if their doctor said it was possible (88%). Age, sex and therapeutic area had no influence on the general attitudes towards deprescribing. Taking more than ten medicines was significantly associated with a higher perceived medication burden. Antihypertensive medication and insulin were considered more appropriate than statins, and insulin was considered more appropriate than sulfonylureas not favouring deprescribing. CONCLUSIONS The majority of older people using cardiometabolic medication are willing to stop one of their medicines if their doctor said it was possible. Health care providers should take into account that patients perceive some of their medication as more appropriate than other medication when discussing deprescribing.
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Affiliation(s)
- Stijn Crutzen
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
- Universitair Medisch Centrum Groningen, Petra Denig Clinical Pharmacy and Pharmacology, EB70, Postbus 30.001, Hanzeplein1, 9700 RB, Groningen, The Netherlands.
| | - Jamila Abou
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Sanne E Smits
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gert Baas
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Theda Mansholtstraat 5B, 2331 JE, Leiden, The Netherlands
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Katja Taxis
- Unit of PharmacoTherapy, Epidemiology and Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
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Abstract
PURPOSE OF REVIEW Statins have proven efficacy with a favorable safety profile yet, despite being widely affordable, remain profoundly underutilized. Statins have acquired a bad reputation, which is likely contributing to high rates of nonadherence and discontinuation. The degree to which negative media perceptions contribute to underutilization is unclear. RECENT FINDINGS The media has a key role in informing discussion on the public agenda but also on how issues are framed. In this context, the majority of studies evaluating news coverage suggest that the content on statins is predominantly negative and focused on potential harm. Studies utilizing quasi-experimental and interrupted time series design have shown periods of negative news stories on statins in multiple countries are associated with (a) less statin commencement in eligible patients, (b) high rates of discontinuation, and (c) poor long-term adherence. This review highlights the deleterious impact of negative media coverage on statin utilization through misattribution of muscle complaints and the nocebo effect. Academia must work with the media to harmonize the public health messaging; however, individual physicians have a critical role in mitigating a harmful narrative of misinformation and actively discredit malinformation.
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Affiliation(s)
- Adam J Nelson
- Duke Clinical Research Institute, Duke University, Durham, NC, US.,South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Rishi Puri
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland Clinic, Cleveland Clinic JB-20, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Cleveland Clinic Coordinating Center for Clinical Research (C5R), Cleveland Clinic, Cleveland Clinic JB-20, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Parker K, Wong J. Is polypharmacy an increasing burden in chronic kidney disease? The German experience. Clin Kidney J 2019; 12:659-662. [PMID: 31584570 PMCID: PMC6768297 DOI: 10.1093/ckj/sfz072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Indexed: 02/07/2023] Open
Abstract
This is a commentary article describing the key findings of the German chronic kidney disease (GCKD) study and how these relate to current practice. With the GCKD study showing high levels of polypharmacy, this article discusses ways to ensure that polypharmacy is appropriate and the difficulties faced within a chronic kidney disease population. Suggestions of ways to minimize medication burden in renal patients provide some practical advice for clinicians.
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Affiliation(s)
- Kathrine Parker
- Department of Pharmacy, Manchester University NHS Foundation Trust, Manchester, UK
| | - Joanne Wong
- Department of Pharmacy, Manchester University NHS Foundation Trust, Manchester, UK
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Levy AE, Huang C, Huang A, Michael Ho P. Recent Approaches to Improve Medication Adherence in Patients with Coronary Heart Disease: Progress Towards a Learning Healthcare System. Curr Atheroscler Rep 2018; 20:5. [PMID: 29368179 DOI: 10.1007/s11883-018-0707-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW Non-adherence to medications for the secondary prevention of myocardial infarction (MI) is a major contributor to morbidity and mortality in these patients. This review describes recent advances in promoting adherence to therapies for coronary artery disease (CAD). RECENT FINDINGS Two large randomized controlled trials to "incentivize" adherence were somewhat disappointing; neither financial incentives nor "peer pressure" successfully increased rates of adherence in the post-MI population. Patient education and provider engagement appear to be critical aspects of improving adherence to CAD therapies, where the provider is a physician, pharmacist, or nurse and follow-up is performed in person or by telephone. Fixed-dose combinations of CAD medications, formulated as a so-called "polypill," have shown some early efficacy in increasing adherence. Technological advances that automate monitoring and/or encouragement of adherence are promising but seem universally dependent on patient engagement. For example, medication reminders via text message perform better if patients are required to respond. Multifaceted interventions, in which these and other interventions are combined together, appear to be most effective. There are several available types of proven interventions through which providers, and the health system at large, can advance patient adherence to CAD therapies. No single intervention to promote adherence will be successful in all patients. Further study of multifaceted interventions and the interactions between different interventions will be important to advancing the field. The goal is a learning healthcare system in which a network of interventions responds and adapts to patients' needs over time.
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Affiliation(s)
| | - Carrie Huang
- University of Southern California, Los Angeles, California, USA
| | - Allen Huang
- University of Southern California, Los Angeles, California, USA
| | - P Michael Ho
- Department of Medicine, Denver VA Medical Center, Denver, CO, 80220, USA
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10
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Levy AE, Ho PM. Nonadherence in the Learning Healthcare System: Avoiding a Mountain by Seeing the Bumps. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.117.004283. [PMID: 29021335 DOI: 10.1161/circoutcomes.117.004283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew E Levy
- From the Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (A.E.L.); and VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver (P.M.H.)
| | - P Michael Ho
- From the Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (A.E.L.); and VA Eastern Colorado Health Care System, University of Colorado School of Medicine, Denver (P.M.H.).
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11
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Kriegbaum M, Lau SR. Medication non-adherence and uncertainty: Information-seeking and processing in the Danish LIFESTAT survey. Res Social Adm Pharm 2017; 14:736-741. [PMID: 29203408 DOI: 10.1016/j.sapharm.2017.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Statins are widely prescribed to lower cardiovascular morbidity and mortality. However, statin non-adherence is very high. PURPOSE The aim of this paper was to investigate reasons for stopping statin treatment in the general population and to study how aspects of information-seeking and processing is associated with statin non-adherence. METHODS This study used a population survey on 3050 Danish residents aged 45-65 years. Reasons for statin discontinuation was studied among those who were previous statin users. The association between information seeking and processing and statin discontinuation were analysed using multivariate logistical regression models. RESULTS Experience of side effects and fear of side effects played an important role in the discontinuation of statin treatment. Feelings of uncertainty and confusion regarding information on statins predicted statin discontinuation. This applied to information from both mass media and from general practitioners. There was no clear pattern of information seeking and statin non-adherence. CONCLUSIONS The article point to the impact of information-seeking on the decision to take cholesterol-lowering medication. This included contributions from information disseminated by media outlets. Side effects and fear of side effects should be addressed in clinical practice. Health care professionals should pay attention to emotional aspects of how information is disseminated and perceived by statin users.
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Affiliation(s)
- Margit Kriegbaum
- Department of Public Health, University of Copenhagen, Denmark, Copenhagen, Denmark.
| | - Sofie Rosenlund Lau
- Department of Anthropology, University of Copenhagen, Denmark, Copenhagen, Denmark
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