Harrison TN, Derose SF, Cheetham TC, et al.
Am J Manag Care. 2013;19(4):e133-e139

Background

Cardiovascular disease (CVD) is associated with high direct and indirect costs. Since hypercholesterolemia is a well-known risk factor for CVD, management of elevated cholesterol levels can prevent CV events en possibly reduce healthcare costs. Statins are widely used for this purpose.
However, the potential public health benefits of statins depend on adherence to treatment. Evidence suggests that adherence to statin therapy is suboptimal. Patients who never fill the initial prescription represent primary nonadherence, while secondary nonadherence focuses on refill rates.
In order to improve adherence and ultimately reduce adverse CVD events, it is important to understand self-reported factors that result in unclaimed prescriptions. This study therefore explored self-reported reasons for primary nonadherence among patients with a newly prescribed statin medication, in a sample of participants in a randomized controlled trial evaluating an automated system to increase adherence to newly prescribed statins [1]. 98 individuals who had a new statin prescription that had not been filled within 1 or 2 weeks of being ordered were questioned in a structured telephone interview about the reasons for not filling the prescription, among other things.

Main results

• Twelve weeks post-index date, 74.5% of respondents reported that they had not filled their statin prescription. The most commonly cited reasons were general concerns about taking the medication (63.0%), a decision to try lifestyle modifications such as diet and exercise  instead of taking the medication (63.0%) and fear of side effects (53.4%).
• 39% of respondents perceived the statin medication as unnecessary while 34.7% did not believe their condition to be life-threatening. 16.4% was concerned about drug interactions. 16.4% did not want to take any more medications since they perceived they already took too many.
• 32.9% of respondents reported inadequate health literary. 16.9% reported requiring help when reading medical material, 17.1% reported having problems learning about their medical condition and 29.6% were not confident completing health forms alone.

Conclusion

Reasons for primary nonadherence to statin therapy are multifactorial. Improvement of adherence may need individualised interventions. Different strategies to improve patient-physician communication should be explored and examined in a larger population to ensure the greatest impact.

References

1. Derose SF, Green K, Marrett E, et al. Automated outreach to increase primary adherence to cholesterol-lowering medications. JAMA Intern Med. 201;173(1):38-43.

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