Side-Effect Concerns, Herbal Options Among Reasons for Not Filling Statins Scrips

April 25, 2013

PASADENA, CA — In a small survey of patients who failed to fill their prescription for statin therapy, more than half reported not doing so because of concerns about side effects, while two out of every three patients expressed general concerns about taking the lipid-lowering medication[1].

Similarly, a majority of patients decided to try making changes to their lifestyle before filling the prescription at the pharmacy.

"Most respondents in our study who were nonadherent with their initial statin prescription had general concerns about the medication and a preference for lifestyle modifications," write Teresa Harrison (Kaiser Permanente Southern California, Pasadena) and colleagues in the American Journal of Managed Care. "To a lesser extent, respondents expressed concerns about side effects, drug interactions, and polypharmacy and did not perceive a need for statin therapy. Cost of the statin prescription was not reported as a primary factor for respondents' failure to redeem their prescription. "

The telephone survey included 98 patients enrolled in the Kaiser Permanente Southern California managed care health plan. The individuals were eligible for the survey if they were at least 24 years old and had a new statin prescription that had not been filled within one to two weeks of being ordered.

Of the 98 participants, 74.5% had not filled their statin prescriptions, while 20.4% reported filling the statin prescription at a non–Kaiser Permanente pharmacy. For the 73 individuals who had not filled the prescription, 63.0% said they had "general concerns" about taking the medication, while 53.4% said they feared side effects from the lipid-lowering medications. In addition, 63.0% said they planned to alter their diet and begin exercising before starting their medication.

Interestingly, nearly 40% of patients felt the medication was unnecessary, while 35% did not consider their condition life-threatening. One-third of all respondents who left the statin prescription unfilled said they were currently taking nonprescription alternatives, including over-the-counter supplements or herbs, to lower their cholesterol levels. A smaller proportion of patients said they already took too many prescription drugs, and others were concerned about drug interactions.

"Respondents' reasons for primary nonadherence to statin therapy are multifactorial," write the researchers. "Therefore, individualized interventions aimed at improving primary nonadherence may be warranted. For example, it may be helpful to institute interventions at the time of the initial prescription that address patients' negative perceptions of statins while emphasizing the benefits of statin therapy for reducing cardiovascular morbidity and mortality."

Regarding the health literacy of the respondents, 33% of respondents said they felt it was inadequate, and 17% reported needing help to read medical material. In addition, 17% said they had problems learning about their medical condition, and one-third were not confident filling out health forms.

The researchers state that cost did not appear to be a barrier for failing to fill the statin prescription, with just 12% of respondents citing financial hardship as the reason for not picking up the prescription. "A small but noteworthy number of respondents reported not being aware of their physician having prescribed the statin medication, which suggests a need for improved patient–physician communication," write Harrison and colleagues.

This research was funded by Merck Sharp and Dohme. Harrison reports she has no conflicts of interest. Disclosures for the coauthors are listed in the paper.

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