Introduction
Statins are a proven therapy to lower serum cholesterol concentrations, reducing the long-term risk of ischaemic heart disease events by about 60% and stroke by 17% 1. Despite these therapeutic advantages, medication adherence to statins (defined as the extent to which the patient’s medication taking behavior corresponds with the agreed recommendations from the healthcare provider) is suboptimal and varies between 32-77%2-8.
Non-adherence to statin therapy has a negative impact on treatment outcomes. Patients with poor adherence to statins are at greater risk of cardiovascular events and hospitalization due to cardiovascular disease and cause avoidable high health care costs 9-15. This makes improving medication adherence to statin therapy a key component of the treatment of hypercholesteremia 9,16.
Adherence is multifactorial; “Health-system/Health-care team factors”, “Social/economic factors”, “Condition-related factors”, “Therapy-related factors” and “Patient-related factors” have been associated with/implicated in non-adherence 9.. Previous research on interventions to improve adherence to statins mainly focused on “patient-related factors”, however these studies yielded small inconsistent results, with a range of effect of these interventions from -3% up to 25% improvement of adherence17-20. Therefore, interventions that target other factors that can have impact on adherence might also be required, like relevant factors in the health-system/health-care 9. Yet, evidence on the impact of health-system/health-care team factors on implementation adherence to statins is scarce. Insight into the association between relevant factors in the health system/health-care team and adherence is warranted.
Earlier studies demonstrated health system factors like continuity of care and complete treatment information are factors that are positively associated with adherence to drug treatment in chronic conditions as well as in statin use 16,21,22. Furthermore, patients who experienced a higher quality of care and/or a higher degree of shared decision making had more knowledge of their illness, were more actively involved in their own treatment, were more confident in their communication with healthcare providers and had higher adherence rates23,24. The aforementioned examples in literature are about the impact of the overall quality of care on adherence, whereas literature about the impact of the quality of care activities employed by individual HCPs is scarce. Based on the findings about the positive impact of the overall quality of care on adherence, it is also conceivable that quality of care activities, including usual care adherence support activities) of a single HCP, might positively influence patients’ medication adherence. Noteworthy, influencing the usual care of one single healthcare provider may affect the adherence of several patients, which makes interventions on HCP level potentially more impactful than interventions on patient level. Currently, no evidence is available about physicians’ and pharmacy staff’s’ usual care to support adherence to statins and how this care affects patients’ adherence.
The aim of this study is 1) to describe the nature and extent of adherence supporting activities provided in a usual care setting by physicians, pharmacists and pharmacy technicians; and 2) to examine the relation between the extent of adherence supporting activities of physicians, pharmacists and pharmacy technicians and adherence to statins. We hypothesized that increased HCPs’ usual care activities to support statin adherence have a positive impact on patients’ implementation adherence to statins.