The problem identified in the case study
The study was aimed at solving the problem of statin nonadherence. Reese et al highlighted that nearly half of patients who were prescribed statin medication to treat acute coronary syndrome stop taking them after six months. This is in spite of the documented and substantiated benefits associated with the use statins. Statins, or HMG-CoA reductase inhibitors, are required by a majority of patients suffering from cardiovascular disease (CVD) or its equivalent in regards to cardiovascular risk1.
Patients with cardiovascular risk condition, such as diabetes, are able to reach acceptable levels of cholesterol in the blood through the use of statin. It is important to note that CVD is the leading cause of death in the US. This requires the development of a healthcare strategy that will eventually increase statin adherence among this patients1.
Medical adherence refers to whether take their prescribed medication as recommended i.e. once/twice daily. In addition, adherence refers to whether the patient continuously takes their prescribed medication. Medical nonadherence is prevalent in spite of its well documented adverse outcomes. In cardiovascular care nonadherence is very common2. Jackevicius et al noted that ~25% of discharged cardiac patients stopped taking their medication after a week. Furthermore, the researchers found a worrying trend among patients that received medication to treat acute myocardial infarction – β-blockers, statin, and aspirin. 12% of the patients stopped taking all the three medications within 1 month, and more that 30% ceased taking at least one3.
Statins are used to lower LDL-cholestrol effectively lowering the cardiovascular risk of millions of people across the world. Newby et al found that generally only 44% of patients reported persistent statin use. Other related studies further illustrated that less than half of patients with acute coronary syndrome were still adherent after 2 years, and the adherence rate was even lower for patients with chronic coronary artery disease. For cardiovascular conditions in general adherence rates vary widely. This is mostly due to the different methods used for assessment2.
Studies continuously show a link between non-adherence to cardiovascular medication and increased risk of mortality and morbidity. Nonadherence to statin within 12 months of hospitalization led to a 12% to 25% increase in mortality for patients with a history of myocardial infarction2. The figures are much higher in patients with a chronic coronary artery disease. Non adherence has been associated with a 40% increase in risk of cardiovascular hospitalization, as well as an 80% increase in mortality. The studies highlight the efficacy of cardiovascular medication, and the high risk associated with nonadherence3.
Other viable solutions have been presented to improve statin adherence.
- Reinforcements and reminders for patients.
These methods have been shown to increase statin adherence by ~25%. This should also include improved patient education and information. The method involves the use of written information provided to the patients, additional discussion time with the physician, and reminders through mail and phone2.
- Use of patient data to foster interventions and follow-ups by trained healthcare professionals.
In this case, interventions involve the use of ancillary healthcare professionals to provide additional motivation for the patients to adhere to their prescriptions. In some places, adherence has benefited from the simplification of the medication regimen. In a study, the use of combination pills increased the overall adherence rate by 11%3.
- Focus on the Physician-Patient relationship.
Enhanced dialogue between the patient and the physician improves adherence. The provision of comprehensive knowledge on statin use, even to those already under statin therapy leads to the achievement of LDC-cholesterol lowering goals2.
The case study addresses the problem of statin non adherence in diabetes patients. Studies continuously show a link between non-adherence to cardiovascular medication and increased risk of mortality and morbidity. Nonadherence to statin within 12 months of hospitalization led to a 12% to 25% increase in mortality for patients with a history of myocardial infarction. The problem will be solved through the use of social forces in an attempt to increase the adherence rate to at least 80%.
- Reese P, Kessler J, Doshi J et al. Two Randomized Controlled Pilot Trials of Social Forces to Improve Statin Adherence among Patients with Diabetes. J GEN INTERN MED. 2015;31(4):402-410. doi:10.1007/s11606-015-3540-y.
- Maningat P, Gordon B, Breslow J. How Do We Improve Patient Compliance and Adherence to Long-Term Statin Therapy?. Curr Atheroscler Rep. 2012;15(1). doi:10.1007/s11883-012-0291-7.
- Jackevicius C, Mamdani M, Tu J. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. ACC Current Journal Review. 2002;11(6):36. doi:10.1016/s1062-1458(02)00915-7.