Patient perspectives on primary statin nonadherence

项目摘要 心血管疾病（CVD）是美国发病率、死亡率和卫生保健的主要原因 虽然成本很高，但经证实的CVD风险降低策略往往没有得到充分利用。药物如HMGCoA 还原酶抑制剂，通常被称为“他汀类药物”，可以降低CVD风险。然而，高达34%的患者 从不服用新处方的他汀类药物（原发性不依从），因此无法降低他们的CVD风险。 关于原发性非依从性的数据很少。有限的数据反直觉地表明， 在一些CVD风险较高的人群中，如黑人和西班牙裔，原发性他汀类药物不依从性 拉丁美洲人，但这些差异的原因是未知的。关于相互作用的信息不完整 患者，医疗保健系统和提供者因素的基本不遵守，以及关于类型和 可能鼓励主要他汀类药物依从性的激励策略的内容。关键是要准确地 确定主要他汀类药物不依从的原因，以最终帮助人们降低CVD风险。 该研究议程的长期目标是通过开发针对患者的定制治疗方案来降低CV风险。 干预措施，以促进药物治疗的依从性。这项研究将有助于全面了解 患者选择不服用新处方他汀类药物的原因，以及患者对以下解决方案的偏好： 克服主要的不遵守。这项横断面研究分为两个阶段。在第一阶段，焦点小组和 对中年和老年白色人、黑人、讲英语和西班牙语的人进行半结构化访谈 西班牙裔/拉丁裔患者将产生开放式数据，探索患者决定不填写的原因范围 初始他汀类药物处方（关注患者的态度和信念），并征求潜在解决方案的想法， 克服这些障碍。在第二阶段，我们将开发和试点测试一个结构化的调查， 患者队列（Aim 2）。认知访谈将用于完善调查内容和措辞。合格研究 将通过查询PCORnet（PCRI的国家临床）的标准化数据库来识别患者 研究网络）患者驱动的研究网络（健康eHeart）（第1阶段）和PCORnet 临床数据研究网络（pScanner）和加州大学医疗保健系统（UC雷克斯）， 阶段1和2。本研究的具体目标是：1）确定：a）患者的态度，信念和其他因素 与原发性他汀类药物不依从性相关，以及B）患者克服这些障碍的建议;以及2） 开发并试点测试英语和西班牙语调查，以了解患者特征（例如， 人口统计学、健康状况），涉及：a）患者报告的主要他汀类药物不依从的原因和B）首选 克服原发性他汀类药物不依从性的策略。我们希望这项研究能够提供关键的初步研究。 为设计和进行未来更大规模的调查提供信息，这反过来又将为 定制的针对患者的干预措施，以减少原发性他汀类药物不依从性，并最终降低CVD风险。

Project Summary Cardiovascular disease (CVD) is the United States' leading cause of morbidity, mortality, and health care costs, but proven CVD risk reduction strategies are often not fully used. Medications such as HMGCoA reductase inhibitors, commonly referred to as “statins,” can reduce CVD risks. However, up to 34% of patients never fill a newly prescribed statin (primary nonadherence), and consequently fail to reduce their CVD risk. Data about primary nonadherence are sparse. The limited data counterintuitively suggest higher rates of primary statin nonadherence in some populations at greater risk for CVD, such as blacks and Hispanics/ Latinos, but the reasons for these disparities are unknown. There is incomplete information about the interplay of patient, healthcare system and provider factors underlying primary nonadherence, and about the type and content of motivational strategies that might encourage primary statin adherence. It is crucial to accurately identify reasons for primary statin nonadherence order to ultimately help people lower their CVD risk. The long-term goal of this research agenda is to reduce CV risk by developing patient-targeted tailored interventions to promote medication adherence. This study will contribute a comprehensive understanding of the reasons that patients choose not to fill a newly prescribed statin, and patient preferences for solutions to overcome primary nonadherence. This cross-sectional study has two phases. In Phase 1, focus group and semi-structured interviews with middle-aged and older white, black, and English- and Spanish-speaking Hispanic/Latino patients will yield open-ended data exploring the range of reasons patients decide not to fill initial statin prescriptions (focusing on patient attitudes and beliefs), and solicit ideas for potential solutions to overcome these barriers. In Phase 2, we will develop and pilot-test a structured survey with a separate patient cohort (Aim 2). Cognitive interviews will be used to refine survey content and wording. Eligible study patients will be identified by querying standardized databases from a PCORnet (PCORI's National Clinical Research Network) Patient-Powered Research Network (Health eHeart) (Phase 1) and from a PCORnet Clinical Data Research Network (pScanner) and the University of California healthcare system (UC ReX) for Phases 1 and 2. The study's specific aims are to: 1) determine: a) patient attitudes, beliefs, and other factors associated with primary statin nonadherence and b) patient suggestions to overcome these barriers; and 2) develop and pilot-test English- and Spanish-language surveys to understand patient characteristics (e.g., demographics, health) related to: a) patient-reported reasons for primary statin nonadherence and b) preferred strategies to overcome primary statin nonadherence. We expect this study to provide critical preliminary information for the design and conduct of a future larger-scale survey, which will in turn inform the content of tailored patient-targeted interventions to reduce primary statin nonadherence, and ultimately reduce CVD risks.