Associations between patients’ adherence and GPs’ attitudes towards risk, statin therapy and management of non-adherence—a survey and register-based study

Barfoed, Benedicte Marie Lind; Paulsen, Maja Skov; Christensen, Peter O.; Halvorsen, Peder Andreas; Jarbøl, Dorte Ejg; Larsen, Mogens Lytken; Munch, Maria; Søndergaard, Jens; Nielsen, Jesper Bo

doi:10.1093/fampra/cmw005

Cited by 5 publications

(3 citation statements)

References 14 publications

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“…Motivating adherence for both behavioral and pharmaceutical changes remains a challenge for FPs. Despite that behavioral change is a highly effective prevention strategy, patient motivation and adherence to lifestyle recommendations are an obstacle to preventive care [12], [13]. A multifaceted approach at primary care settings, including controlled physical exercise, follow-up calls, and prescription reminders in addition to ongoing FP services, can improve patient adherence to prescribed medications and behavioral changes, while addressing barriers such as time and resource constraints for FPs [14], [15].…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Application of Cardiovascular Disease Prevention Guidelines among Family Physicians: A Cross-sectional Study

Korzh

Nikolenko

Titkova

et al. 2021

Open Access Maced J Med Sci

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BACKGROUND: Family physicians (FPs) play an important role in the prevention of cardiovascular disease (CVD). AIM: This study aims to assess the determinants of FPs’ knowledge and application of cardiovascular preventive management guidelines at primary health-care setting in Ukraine. MATERIALS AND METHODS: We performed a cross-sectional study conducted among the 226 FPs in Kharkiv Region, Ukraine. A self-administrated questionnaire was administered, exploring demographic, job characteristics, knowledge of CVD prevention guidelines, and application of CVD guidelines’ questions about the essential items related to diagnosis and management of CVD according to the international/local guidelines. RESULTS: The results show a very low level of knowledge of guidelines among FPs with 85.8% scoring below the acceptable knowledge level. The guidelines were applied below the acceptable level with 51.3% scoring below the cutoff point. The results indicate that both average scores were below the minimum acceptable level. Lack of knowledge of the CVD preventive care was considered the biggest barrier (62.8%). Lack of counseling skills was the second major barrier (37.9%). Subjectivity of the questions was considered to be the third barrier (32.6%). Lack of counseling skills was the second major barrier (37.9%). Subjectivity of the questions was considered to be the third barrier (32.6%). CONCLUSIONS: Recognizing the low level of knowledge and application of guidelines among primary care providers and working toward minimizing this problem can be through education, training, and monitoring of the application. This can potentially improve CVD preventive management among patients.

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Section: Discussionmentioning

confidence: 99%

Knowledge and Application of Cardiovascular Disease Prevention Guidelines among Family Physicians: A Cross-sectional Study

Korzh

Nikolenko

Titkova

et al. 2021

Open Access Maced J Med Sci

View full text Add to dashboard Cite

show abstract

“…Despite behavioural change being a highly cost-effective prevention strategy, 44 45 patient motivation and adherence to lifestyle advice is a barrier to preventive care. 46–49 A multifaceted approach in a primary care setting involving supervised exercise sessions, follow-up calls and timed medication reminders in addition to current GP services can improve patients’ adherence to prescribed medication and behavioural changes, while addressing barriers such as time and resource constraints for GPs. Recent lifestyle intervention trials in a primary care setting revealed reductions in individual risk factors (blood pressure, obesity, cholesterol), and improvements in total mortality as well as fatal and non-fatal cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

General practitioners’ perspectives on the prevention of cardiovascular disease: systematic review and thematic synthesis of qualitative studies

Banks

Calabria

et al. 2018

BMJ Open

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ObjectiveCardiovascular disease (CVD) is a leading cause of morbidity and mortality globally, and prevention of CVD is a public health priority. This paper aims to describe the perspectives of general practitioners (GPs) on the prevention of CVD across different contexts.DesignSystematic review and thematic synthesis of qualitative studies using the Enhancing Transparency of Reporting the Synthesis of Qualitative research (ENTREQ) framework.Data sourcesMEDLINE, Embase, PsycINFO and CINAHL from database inception to April 2018.Eligibility criteria for selecting studiesWe included qualitative studies on the perspectives of GPs on CVD prevention.Data extraction and synthesisWe used HyperRESEARCH to code the primary papers and identified themes.ResultsWe selected 34 studies involving 1223 participants across nine countries. We identified six themes: defining own primary role (duty to prescribe medication, refraining from risking patients’ lives, mediating between patients and specialists, delegating responsibility to patients, providing holistic care); trusting external expertise (depending on credible evidence and opinion, entrusting care to other health professionals, integrating into patient context); motivating behavioural change for prevention (highlighting tangible improvements, negotiating patient acceptance, enabling autonomy and empowerment, harnessing the power of fear, disappointment with futility of advice); recognising and accepting patient capacities (ascertaining patient’s drive for lifestyle change, conceding to ingrained habits, prioritising urgent comorbidities, tailoring to patient environment and literacy); avoiding overmedicalisation (averting long-term dependence on medications, preventing a false sense of security, minimising stress of sickness) and minimising economic burdens (avoiding unjustified costs to patients, delivering practice within budget, alleviating healthcare expenses).ConclusionsGPs sought to empower patients to prevent CVD, but consideration of patients’ individual factors was challenging. Community-based strategies for assessing CVD risk involving other health professionals, and decision aids that address the individuality of the patient’s health and environment, may support GPs in their decisions regarding CVD prevention.

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“… 26 Two Danish studies found adherence to statin treatment to be lower among patients with a more risk-seeking attitude and physicians who did not assess treatment after initiation. 27 28 The reasons that physicians do not adhere to lipid-lowering guidelines may be the same as for the blood pressure target: acceptance of higher values than recommended, competing medical problems. 29 Regardless of reasons for non-adherence, our study shows that there is room for improvement of secondary preventive lipid-lowering therapy.…”

Section: Discussionmentioning

confidence: 99%

Adherence to lipid-lowering guidelines for secondary prevention and potential reduction in CVD events in Swedish primary care: a cross-sectional study

et al. 2020

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ObjectivesThe protective effect of lipid-lowering treatment for secondary prevention after coronary heart disease (CHD) has been well documented. Current guidelines recommend a target level for low-density lipoprotein cholesterol (LDL-C) of ≤1.8 mmol/L. The aim was to describe lipid-lowering treatment patterns and to provide an estimate of the potential reductions in cardiovascular disease (CVD) events with improved adherence to guidelines.DesignCross-sectional.SettingPrimary care in a large Swedish region.Participants37 120 patients with CHD in a Swedish regional primary care quality register (QregPV), by 31 December 2015.Primary and secondary outcome measuresProportion of patients on statin treatment and proportion of patients achieving LDL-C ≤1.8 mmol/L. Estimated number of CVD events calculated for (1) current treatment, (2) improved treatment and (3) lowered LDL-C, based on applying rate reductions from meta-analyses of randomised trials to the potentially undertreated population. Risk estimation modelling was based on 52 042 patients in the same register on January 2011 followed for 5 years.ResultsOf 37 120 patients, 18% reached LDL-C ≤1.8 mmol/L and 32% were not on statin treatment. Based on individual risks, the estimated number of CVD events in the study group over 5 years was 9209/37 120. If all patients without a statin or with less potent statin treatment were given atorvastatin 80 mg, an estimated reduction of CVD events by 14% (7901 vs 9209) was seen. If all patients achieved LDL-C ≤1.8 mmol/L, the number of events was estimated to be reduced by 18% (7577 vs 9209).ConclusionOne-third of patients with CHD in primary care were not on lipid-lowering treatment. Based on the assumption that included patients would react to statin therapy the same way as the patients in randomised trials, improved adherence to treatment guidelines could lead to a substantial reduction in new CVD events.

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Associations between patients’ adherence and GPs’ attitudes towards risk, statin therapy and management of non-adherence—a survey and register-based study

Abstract: Our findings suggest that GPs' attitudes to risk, statin therapy or management of non-adherence are not significantly associated with their patients' adherence.

Cited by 5 publications

References 14 publications

Knowledge and Application of Cardiovascular Disease Prevention Guidelines among Family Physicians: A Cross-sectional Study

Knowledge and Application of Cardiovascular Disease Prevention Guidelines among Family Physicians: A Cross-sectional Study

General practitioners’ perspectives on the prevention of cardiovascular disease: systematic review and thematic synthesis of qualitative studies

Adherence to lipid-lowering guidelines for secondary prevention and potential reduction in CVD events in Swedish primary care: a cross-sectional study

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