Barriers and Facilitators to Using Statins: A Qualitative Study With Patients and Family Physicians

Abstract

Background Despite their proven efficacy to reduce cardiovascular disease, statin medication use remains low in individuals at high risk of cardiovascular disease considering their widespread availability and safety. Our objective was to explore the perspectives of patients and family physicians with regard to the barriers and facilitators of statin use in primary care. Methods In this qualitative descriptive study, we conducted 2 focus groups with patients (number, n = 8/6) and individual semistructured interviews with family physicians (n = 17) from community settings. Interviewers asked participants about barriers to and facilitators of statin use. Focus groups and interviews were digitally recorded, transcribed, and analyzed in duplicate using conventional content analysis. Results Patients were averse to taking statins for a variety of reasons: medication avoidance and burden; inadequate buy-in for statin therapy; and difficulty remembering to take statins regularly. Family physicians perceived similar barriers and reported other barriers: lack of resources such as inadequate tracking systems; specialist-primary care provider guideline discordance; and lack of continuity and relationship. Patients expressed that key facilitators were patient education and support; splitting tablets to increase cost-effectiveness; and changing to a different statin or lower dose in those with side effects. Family physicians described several similar strategies to facilitate therapy as well as shared decision making and clinical decision support tools as enablers for improvement. Conclusions We identified several important barriers to and facilitators of statin use at the patient and prescriber level. This information offers insight into strategies to improve statin use and the development of innovative programs and interventions.

Factors affecting statin uptake among people living with HIV: primary care provider perspectives

“…Primary care providers may also face additional barriers such as large workloads, imbalance between expertise and increasing job demands, and lack of team support [ 17 – 19 ]. At the patient level, barriers to statin uptake in the general population include medication burden, concerns about side effects, and uncertainty about benefits [ 20 – 23 ]. For the care of PLWH specifically, barriers to statin uptake could include those that interfere with antiretroviral therapy and implementation of primary care guidelines more generally, such as lack of perceived need for treatment, lack of engagement in medical care, and psychosocial factors and life circumstances such as mental health issues, drug and alcohol use, stigma, and unstable housing [ 14 , 24 – 26 ].…”

Strategies for enhancing the initiation of cholesterol lowering medication among patients at high cardiovascular disease risk: a qualitative descriptive exploration of patient and general practitioners’ perspectives on a facilitated relay intervention in Alberta, Canada

“…Further information about patient education, shared decision-making and clinical decision support tools are described in our other report from this work. 16 Open access…”

“… 16 On the other hand, patients often experience or fear side effects, or are simply averse to taking additional medications. 16 Furthermore, patients that face social disadvantages such as low income, lack of health insurance, and minority race are more likely to not use statins. 17 A large US-based survey found that side effects were common and that many former statin users were unsatisfied with the explanation provided by their prescriber about the importance of the medication.…”

“…15 Physicians and patients face numerous barriers when it comes to prescribing and adhering to statin therapy, from the providers perspective this includes lack of knowledge, conflicting clinical guidelines, and a lack of systems to identify patients who should be taking statins. 16 On the other hand, patients often experience or fear side effects, or are simply averse to taking additional medications. 16 Furthermore, patients that face social disadvantages such as low income, lack of health insurance, and minority race are more likely to not use statins.…”

Medicinal Chemistry Friendliness of Pigments from Monascus-Fermented Rice and the Molecular Docking Analysis of Their Anti-Hyperlipidemia Properties

“…However, nowadays, many people prefer to use nutraceuticals due to interest in 'natural' avenues of disease control, and the concern of potential drug interactions, long-term safety, and the economic implications of long-term (or life-long) dependence on drugs [5,6]. Moreover, some of the medications used to treat hyperlipidemia e.g., statins have side effects such as nausea, headaches, myalgias, memory loss and cognitive function impairment, and increased risk of diabetes [7][8][9][10][11].…”