Patient perspectives on primary statin nonadherence

项目摘要 心血管疾病(CVD)是美国发病率、死亡率和医疗保健的主要原因 降低成本，但经过验证的降低心血管疾病风险的战略往往没有得到充分利用。HMGCoA等药物 还原酶抑制剂，通常被称为“他汀类药物”，可以降低心血管疾病的风险。然而，高达34%的患者 永远不要服用新开的他汀类药物(主要是不依从性)，因此不能降低他们患心血管疾病的风险。 有关主要不遵守规定的数据很少。有限的数据与直觉相反地表明， 一些心血管疾病风险较高的人群中的初级他汀类药物未被遵守，如黑人和西班牙裔/ 拉美裔，但造成这些差异的原因尚不清楚。关于相互作用的信息是不完整的 患者、医疗保健系统和提供者因素导致原发不坚持，以及关于类型和 可能鼓励初次服用他汀类药物的激励策略的内容。关键是要准确地 找出主要他汀类药物不依从性的原因，最终帮助人们降低心血管疾病的风险。 这项研究议程的长期目标是通过开发针对患者的量身定做来降低心血管风险 促进服药依从性的干预措施。这项研究将有助于全面了解 患者选择不填充新开的他汀类药物的原因，以及患者对解决方案的偏好 克服主要的不坚持。这项横断面研究分为两个阶段。在第一阶段，焦点小组和 对讲英语和西班牙语的中老年白人、黑人、英语和西班牙语人士进行半结构化采访 西班牙裔/拉丁裔患者将提供开放式数据，探索患者决定不填写的原因范围 最初的他汀类药物处方(重点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，我们将开发和试行结构化调查，并使用单独的 患者队列(目标2)。认知访谈将用于改进调查内容和措辞。符合条件的研究 患者将通过查询来自PCORnet(PCORI的国家临床)的标准化数据库来识别 研究网络)患者支持的研究网络(Health EHeart)(第一阶段)和来自PCORnet 临床数据研究网络(PScanner)和加州大学医疗保健系统(UC Rex) 阶段1和阶段2。研究的具体目标是：1)确定：a)患者的态度、信念和其他因素 与主要的他汀类药物不依从性有关，以及b)患者建议克服这些障碍；以及2) 开发和试行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)与：a)患者报告的未坚持使用他汀类药物的原因和b)首选 克服原发他汀类药物不依从性的策略。我们预计这项研究将提供关键的初步 为设计和进行未来更大规模的调查提供的信息，这将反过来为 量身定做的针对患者的干预措施，以减少初级他汀类药物的不依从性，并最终降低心血管疾病的风险。

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.