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DYSLIPIDEMIA

Factors Related to Adherence to Statin Therapy

Clinical Pharmacy Specialist, Department of Pharmacy, Kaiser Permanente Colorado, Aurora, CO

Kari L Olson, PharmD

Clinical Pharmacy Specialist, Department of Pharmacy, Kaiser Permanente Colorado; Clinical Assistant Professor, School of Pharmacy, University of Colorado at Denver and Health Sciences Center

David Magid, MD MPH

Director, Colorado Permanente Clinical Research Unit, Clinical Research Unit, Kaiser Permanente Colorado; Associate Professor, Emergency Medicine and Preventive Medicine, Department of Preventive Medicine and Emergency Medicine, University of Colorado at Denver and Health Sciences Center

Elizabeth Bayliss, MD MSPH

Clinician Researcher, Clinical Research Unit, Kaiser Permanente Colorado; Assistant Professor, Family Medicine, Department of Family Medicine, University of Colorado at Denver and Health Sciences Center

Eli J Korner, PharmD MPH

at time of writing, Kaiser Permanente Colorado and the University of Colorado at Denver and Health Sciences Center; now, Medical Liaison Virology, Scientific Field Operations, Medical Affairs, Roche Laboratories, Inc, Denver

David W Brand, MSPH

Research Operations Supervisor and Senior Project Manager, Clinical Research Unit, Kaiser Permanente Colorado

John F Steiner, MD MPH

Professor, Departments of Internal Medicine and Preventive Medicine, University of Colorado at Denver and Health Sciences Center

Reprints: Dr. Olson, Kaiser Permanente Colorado, 16601 E. Centretech Parkway, Aurora, CO 80011, fax 303/326-7670, kari.olson{at}kp.org

BACKGROUND: Retrospective database analyses have revealed that 50% of patients receiving statins discontinue therapy after one year of treatment. Typically, these data do not focus on patient-specific reasons for discontinuation.

OBJECTIVE: To examine the reasons that patients discontinue statins and compare the patient and clinical factors of those who do and do not discontinue therapy.

METHODS: All patients with a new statin prescription between January 1, 2004, and March 31, 2004, were identified through pharmacy claims. Patients who had discontinued and continued statin therapy were identified. Medical records were reviewed to determine whether there were documented reasons for statin discontinuation. Subsequently, telephone surveys addressing statin knowledge, relationships, communication with healthcare providers, and general health status were conducted.

RESULTS: At one year, 47.5% (n = 671) of patients had obtained fewer than 80% of the refills of their prescribed statin. We reviewed 435 medical records and conducted 255 patient surveys. A total of 29.9% of discontinuers had reasons documented in the medical record. Compared with continuers, fewer discontinuers had follow-up and/or laboratory visits with a provider within 6 months after the start of statin therapy. The surveys indicated that more continuers than discontinuers trusted their providers (p < 0.05) and felt that providers had adequate knowledge to answer their questions (p < 0.001). In contrast, more discontinuers felt the statin was of limited benefit/unsure of the benefit (p < 0.001) and believed that their providers were not interested in their input on their medical condition (p < 0.01).

CONCLUSIONS: Utilizing pharmacy claims records alone to determine statin nonadherence may not only overestimate the percentage of patients who are nonadherent, but also prevent healthcare providers from understanding the reasons that patients discontinue or continue statin therapy. Statin adherence is complex and affected by several factors. Interventions to improve adherence should focus on patient communications, education, and follow-up.

Key Words: adherence, compliance, discontinuation, HMG-CoA reductase inhibitors, statins

Published Online, October 9, 2007. www.theannals.com, DOI 10.1345/aph.1K209

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