Patient and general practitioner attitudes to taking medication to prevent cardiovascular disease after receiving detailed information on risks and benefits of treatment: a qualitative study

Abstract

BackgroundThere are now effective drugs to prevent cardiovascular disease and guidelines recommend their use. Patients do not always choose to accept preventive medication at levels of risk reduction recommended in guidelines. The purpose of the study was to identify and explore the attitudes of patients and general practitioners towards preventative medication for cardiovascular disease (CVD) after they have received information about it; to identify implications for practice and prescribing.MethodsQualitative interviews with GPs and patients following presentation of in depth information about CVD risks and the absolute effects of medication. Setting: GP practices in Birmingham, United Kingdom.ResultsIn both populations: wide variation on attitudes to preventative medication; concerns about unnecessary drug taking & side effects; preferring to consider lifestyle changes first. In patient population: whatever their attitudes to medication were, the vast majority explained that they would ultimately do what their GP recommended; there was some misunderstanding of the distinction between curative and preventative medication. A common theme was the degree of trust in their doctors' judgement and recommendations, which contrasted with scepticism of the role of pharmaceutical companies and academics. Scepticism in guidelines was also common among doctors although many nevertheless recommended treatment for their patientsConclusionsA guideline approach to prescribing preventative medication could be against the interests and preferences of the patient. GPs must take extra care to explain what preventative medication is and why it is recommended, attempt to discern preferences and make recommendations balancing these potentially conflicting concerns.

Patients’ views about taking a polypill to manage cardiovascular risk: a qualitative study in primary care

“…Similar reluctance towards preventive medication for CVD was found in another study. 31 In contrast, Soliman et al 's 9 survey demonstrated high acceptability of a polypill for primary prevention, although this may be because these patients were at high risk and were taking the drug as part of a trial. It may also be a reflection of the different methodology used -survey versus in-depth interviews -as well as a very different healthcare setting and cultural perspective.…”

2013 Esh/Esc Guidelines for the Management of Arterial Hypertension

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Wytyczne ESH/ESC dotyczące postępowania w nadciśnieniu tętniczym w 2013 roku

“…), co sprawia, że czasami zalecenia nie są spójne. Wytyczne często są również postrzegane jako nierealistyczne w odniesieniu do warunków, w jakich funkcjonują na co dzień lekarze [706].…”

“…Nieprzestrzeganie zaleceń dotyczących leczenia stanowi jeszcze istotniejszą przyczynę złej kontroli BP, ponieważ dotyczy dużej liczby pacjentów, a jak w pełni udokumentowano [704][705][706][707][708][709][710], utrzymujące się podwyższone wartości BP wiążą się z wysokim ryzykiem sercowo-naczyniowym. Pacjenci niewspółpracujący zostali sklasyfikowani jako przerywający na stałe terapię oraz źle stosujący leczenie [np.…”