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

Virdee, Satnam; Greenfield, Sheila; Fletcher, Kate; McManus, Richard J; Mant, Jonathan

doi:10.3399/bjgp15x685657

Cited by 16 publications

(24 citation statements)

References 31 publications

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“… 36 Our findings are also in line with a recent UK primary care investigation in which patients considered a secondary prevention polypill acceptable, but were concerned about components interacting and inflexibility of treatment. 37 The inability to adapt polypill dosage and the suitability of fixed dose treatment was a key concern for GPs in our study and has been previously reported in studies exploring polypill attitudes among GPs elsewhere. A small survey of 17 practitioners in New Zealand reported that having no choice of polypill components or doses was the thing GPs disliked most about the concept of a polypill.…”

Section: Discussionmentioning

confidence: 71%

Stroke survivors', caregivers' and GPs' attitudes towards a polypill for the secondary prevention of stroke: a qualitative interview study

et al. 2016

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ObjectivesTo understand the perspectives of stroke survivors, caregivers and general practitioners (GPs) on a polypill approach, consisting of blood pressure and cholesterol-lowering therapies, with or without aspirin, for the secondary prevention of stroke.MethodsA qualitative interview study was undertaken in 5 GP surgeries in the East of England. 28 survivors of stroke/transient ischaemic attack (TIA) were interviewed, 14 of them with a caregiver present, along with a convenience sample of 5 GPs, to assess attitudes towards a polypill and future use. Topic guides explored participants attitudes, potential uptake and long-term use, management of polypill medication and factors influencing the decision to prescribe. Data were analysed using a grounded theory approach. Key themes are presented and illustrated with verbatim quotes.ResultsThe analysis identified 3 key themes: polypill benefits, polypill concerns and polypill lessons for implementation. Stroke/TIA survivors were positive about the polypill concept and considered it acceptable in the secondary prevention of stroke. Perceived benefits of a polypill included convenience resulting in improved adherence and reduced burden of treatment. Caregivers felt that a polypill would improve medication-taking practices, and GPs were open to prescribing it to those at increased cardiovascular risk. However, concerns raised included whether a polypill provided equivalent therapeutic benefit, side effects through combining medications, consequences of non-adherence, lack of flexibility in regulating dosage, disruption to current treatment and suitability to the wider stroke population.ConclusionsParticipants acknowledged potential advantages in a polypill approach for secondary prevention of stroke; however, significant concerns remain. Further research on the efficacy of a polypill is needed to reassure practitioners whose concerns around inflexibility and treatment suitability are likely to influence the decision to prescribe a polypill for secondary prevention of stroke. Acceptability among survivors, caregivers and GPs is likely to determine the uptake and subsequent use of a polypill in the future.

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Section: Discussionmentioning

confidence: 71%

Stroke survivors', caregivers' and GPs' attitudes towards a polypill for the secondary prevention of stroke: a qualitative interview study

et al. 2016

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“…As a result, healthcare systems as well as scientific societies should develop different strategies, including ongoing medical education in order to mitigate these barriers. It is very likely that implementing a polypill strategy in clinical may avoid several millions of fatal and nonfatal cardiovascular events every year worldwide [45,[76][77][78]. …”

Section: Future Perspectivementioning

confidence: 99%

Improving Cardiovascular Protection: Focus On a Cardiovascular Polypill

Barrios

Escobar

2015

Future Cardiol.

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Lack of adherence may explain, at least in part, the poor cardiovascular risk factors control observed in patients with ischemic heart disease, increasing the risk of developing new events. Polypill improves medication adherence, which may actually reduce blood pressure and LDL cholesterol compared with the drugs given separately. The fixed combination of acetylsalicylic acid 100 mg + ramipril 2.5, 5, or 10 mg + either simvastatin 40 mg or atorvastatin 20 mg is the unique cardiovascular polypill that has been registered in 22 countries worldwide. The polypill-containing simvastatin has been specifically tested in a clinical trial including only patients with ischemic heart disease. The FOCUS study showed that patients treated with the polypill showed a higher adherence compared with those receiving separate medications.

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“…This review has examined patients’ overall experience with the health check programme, rather than high‐risk individuals respond to risk‐reducing interventions, including lifestyle and medication uptake and adherence. Previous qualitative evidence has suggested that patients question the necessity of taking medications for the primary prevention of CVD and express concerns over medications’ side‐effects . However, patients considered it legitimate to prescribe medications for high‐risk patients, subject to regular monitoring for side‐effects and medication effectiveness …”

Section: Introductionmentioning

confidence: 99%

Engagement with advice to reduce cardiovascular risk following a health check programme: A qualitative study

Alageel

Gulliford

Wright

et al. 2019

Health Expectations

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Background:The success of a cardiovascular health check programme depends not only on the identification of individuals at high risk of cardiovascular disease (CVD) but also on reducing CVD risk. We examined factors that might influence engagement and adherence to lifestyle change interventions and medication amongst people recently assessed at medium or high risk of CVD (>10% in the next 10 years).Method: Qualitative study using individual semi-structured interviews. Data were analysed using the Framework method.Results: Twenty-two participants (12 men, 10 women) were included in the study. Four broad themes are described: (a) the meaning of 'risk', (b) experiences with medication, (c) attempts at lifestyle change, and (d) perceived enablers to longer-term change. The experience of having a health check was mostly positive and reassuring.Although participants may not have understood precisely what their CVD risk meant, many reported efforts to make lifestyle changes and take medications to reduce their risk. Individual's experience with medications was influenced by family, friends and the media. Lifestyle change services and family and friends support facilitated longerterm behaviour change.Conclusions: People generally appear to respond positively to having a CVD health check and report being motivated towards behaviour change. Some individuals at higher risk may need clearer information about the health check and the implications of being at risk of CVD. Concerns over medication use may need to be addressed in order to improve adherence. Strategies are required to facilitate engagement and promote longer-term maintenance with lifestyle changes amongst high-risk individuals. K E Y W O R D Scardiovascular disease, cardiovascular prevention, NHS Health Check, qualitative research | INTRODUC TI ONCardiovascular disease (CVD) is a major cause of death globally 1 and accounts for around 160 000 deaths annually in the United Kingdom (UK). 2 A large proportion of CVD might be preventable through modification of behavioural risk factors (smoking, lack of physical activity) and taking preventive medication. There is evidence that multiple risk factor interventions for people without CVD, with or 194 | ALAGEEL Et AL.without pharmacological treatments, appear to have little impact on CVD risk and CVD risk factors 3,4 or on the risk of coronary heart disease mortality or morbidity. 5Evidence suggests that communicating information about disease risk to people is challenging and complex. 6 Risk information on its own is not effective and needs to be coupled with other intervention elements to promote healthy behaviour. 7 A systematic review of the literature of providing coronary risk information to adults suggested that whilst global risk information seems to improve the accuracy of risk perception, there is no evidence that risk perception translated into lifestyle changes. 7 Providing risk information to health-care providers appeared to increase medication prescribing, 7 but the evidence is unclear of the efficacy o...

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

Cited by 16 publications

References 31 publications

Stroke survivors', caregivers' and GPs' attitudes towards a polypill for the secondary prevention of stroke: a qualitative interview study

Stroke survivors', caregivers' and GPs' attitudes towards a polypill for the secondary prevention of stroke: a qualitative interview study

Improving Cardiovascular Protection: Focus On a Cardiovascular Polypill

Engagement with advice to reduce cardiovascular risk following a health check programme: A qualitative study

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