Overcoming Barriers to Statin Adherence

Arden Bui, PharmD Candidate 2021; Juwon Kwon, PharmD; Jennifer Kim, PharmD, BCPS, BCACP, CPP; Austin Lucas, PharmD

Disclosures

US Pharmacist. 2019;44(6):19-22. 

In This Article

Pharmacist Adherence Interventions

Pharmacists interact frequently with patients and can intervene to promote positive medication-taking behaviors.[31–33] Table 3 lists examples of strategies to support statin adherence. Providing face-to-face counseling, phone calls, and home visits, and simplifying regimens and reviewing medication-refill information have shown significant adherence improvements.[9,34] Pharmacist counseling can lead to the most remarkable improvements in medication use, especially considering that patients with lower perceived CVD risk are less likely to adhere to statins.[8,35,36] Hyperlipidemia can be symptomless, rendering the benefits of statin therapy difficult to notice.[8] A statin decision aid available on the Mayo Clinic website supports clinical assessments, provides educational visual aids, and can be embedded into the electronic health record (EHR).[37]

A retrospective cohort study evaluating counseling programs in community pharmacies revealed that patients who received brief counseling sessions conducted by a pharmacist upon statin initiation demonstrated significantly greater medication adherence and persistence than patients who did not receive counseling.[34] In-person pharmacist interventions held at the site of medication dispensing showed one of the highest rates of success among various modes of delivery to improve adherence, according to a systematic review.[38] For patients with CVD, postdischarge care has been found to improve adherence following MI.[39,40]

"Providing face-to-face counseling, phone calls, and home visits, and simplifying regimens and reviewing medication-refill information have shown significant adherence improvements. Indirect communication, such as text messaging, can also improve statin adherence."

Indirect communication can also improve statin adherence.[38] One meta-analysis concluded that text messaging doubled the odds of medication adherence (odds ratio, 2.11; P <.001).[41] For patients unreachable by phone, a 6-month pre-post study mailed letters to 460 patients with a late refill for an oral antidiabetic, statin, ACE inhibitor, or angiotensin receptor blocker; 24.1% of patients became adherent after the mailing (P <.001).[42]

Derose and colleagues combined automated telephone calls with a mailed letter for patients who discontinued statins the prior year.[43] The group that received communication had better adherence compared with the group with no outreach (relative risk, 1.63; 95% CI, 1.50–1.76).

Switching a multipill combination (MPC) to a single-pill combination (SPC) can reduce pill burden and result in fewer copays if accessible and/or covered by insurance. A retrospective study compared adherence to SPC versus MPC lipid-modifying medications. The SPC patients were 32% more likely to be adherent to treatment than were the MPC patients.[44] Although not available in the United States, an SPC of aspirin, statin, and two blood pressure medications increased adherence by 21% in patients with or at risk of CVD compared with usual care.[45]

Since socioeconomically challenged patients are prone to lower medication adherence and are at higher risk for CVD mortality, incentives may improve outcomes in these patients.[46] A randomized trial demonstrated increased statin adherence rates in patients who each received $172 over 1 year compared with those who did not (34% vs. 27%; P = .01).[47] Providing financial incentives to both physicians and patients led to the most significant effect on adherence rates (39% vs. 27%; P <.001) and LDL-cholesterol reduction (8.5 mg/dL; 95% CI, 3.8–13.3; P = .002) compared to controls.

Although financial incentives may not seem feasible in every setting, promoting medication adherence, whether through incentives or other strategies, can improve clinical outcomes, thereby averting subsequent costs associated with poor health. Medication adherence initiatives can also increase revenue (e.g., clinic visits for therapy monitoring, prescriptions being filled on schedule, pay-for-performance reimbursement).[31] The EHR can be maximized to allocate resources to patients who would benefit most from these interventions (those with CVD risk and/or predictors of statin nonadherence).[48]

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