Could the polypill improve adherence? The patient perspective

Abstract

INTRODUCTION: Multiple medications are recommended for the management of ischaemic heart disease. Unfortunately, increasing the number of medicines reduces adherence to medicines therapy. The concept of a polypill with a fixed dose combination of the common cardiovascular medicines (aspirin, statin, two blood pressure–lowering medicines) has been promoted. Patient perceptions about this concept have not been explored. METHODS: People taking at least three cardiovascular medicines were interviewed using a semi-structured interview about their views on a polypill that could reduce the number of tablets they would need to take. FINDINGS: The participants considered that the polypill would be very convenient, especially when travelling and would reduce the pill burden. If the polypill was subsidised by the government, they would have reduced dispensing fee costs. There were concerns around the inflexibility of dosing of individual components of the polypill, and some concerns about safety and efficacy. Medical practitioners were identified as having an important role in influencing participants about the acceptability of the polypill. CONCLUSION: Generally the concept of the polypill was acceptable to participants, primarily because of the convenience and reduced number of tablets required daily. There were concerns about whether the polypill would be as effective and safe as the individual medicines. KEYWORDS: Cardiovascular diseases; medication adherence; prevention

Effect of fixed dose combination treatment on adherence and risk factor control among patients at high risk of cardiovascular disease: randomised controlled trial in primary care

“…The main reasons for discontinuing fixed dose combination treatment reported by participants were: medical practitioner decision; not further specified 15 ; dizziness or hypotension 13 ; cough 10 ; patient choice 9 ; deterioration in renal function 6 ; fatigue 6 ; inadequate risk factor control 5 ; unknown reason 4 ; bleed 3 ; gastritis, dyspepsia, or ulcer 3 ; other side effect 13 ; and other reason. 7…”

“…10 11 Health professionals seem open to the theoretical possibility of prescribing fixed dose combination treatment for high risk patients, [12][13][14] and the concept of such a treatment seems generally acceptable to high risk patients taking three or more cardiovascular drugs. 15 However, no data are available on acceptability to both patients and primary care doctors who have had long term experience of fixed dose combination treatment.…”

Treatment of Modifiable Risk Factors Is Associated With Decrease in Coronary Heart Disease Incidence: Time to Use the Polypill

“…Regarding the costs of treatment with the polypill for primary and secondary CVD prevention, several studies have shown that the cost benefits of polypill use were significantly lower than the use of component drugs given separately. In addition, the patient and doctor acceptance of the polypill were significantly higher compared with the component drugs given separately . .…”

“…In addition, no problems have been found between the component drugs of the polypill regarding bioavailability and pharmacokinetic interactions . With respect to the effectiveness and costs of the polypill, these have been shown to be highly acceptable by patients and doctors alike . In fact, the polypill has been called “a best bargain” for the primary and secondary prevention of CVD and strokes.…”

Sustainable Development for the Healthcare Industry

“…According to a recent research (Bryant et al 2013), the majority of patients participating in a survey about reducing the number of pills in cardiovascular treatments found the concept of the polypill very attractive (Yusuf et al 2012).…”