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Research ArticleOriginal Research

Perceptions of Patients with Primary Nonadherence to Statin Medications

Derjung M. Tarn, Maureen Barrientos, Mark J. Pletcher, Keith Cox, Jon Turner, Alicia Fernandez and Janice B. Schwartz
The Journal of the American Board of Family Medicine January 2021, 34 (1) 123-131; DOI: https://doi.org/10.3122/jabfm.2021.01.200262
Derjung M. Tarn
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California–Los Angeles, Los Angeles, CA (DMT); Divisions of Geriatrics and Clinical Pharmacology, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California–San Francisco, San Francisco, CA (MB, JBS); Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, CA (MJP); Department of Sociology, University of California–Los Angeles, Los Angeles, CA (KC); Department of Technology, Operations, and Statistics, Stern School of Business, New York University, New York, NY (JT); Department of Medicine, University of California–San Francisco, San Francisco, CA (AF).
MD, PhD
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Maureen Barrientos
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California–Los Angeles, Los Angeles, CA (DMT); Divisions of Geriatrics and Clinical Pharmacology, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California–San Francisco, San Francisco, CA (MB, JBS); Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, CA (MJP); Department of Sociology, University of California–Los Angeles, Los Angeles, CA (KC); Department of Technology, Operations, and Statistics, Stern School of Business, New York University, New York, NY (JT); Department of Medicine, University of California–San Francisco, San Francisco, CA (AF).
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Mark J. Pletcher
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California–Los Angeles, Los Angeles, CA (DMT); Divisions of Geriatrics and Clinical Pharmacology, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California–San Francisco, San Francisco, CA (MB, JBS); Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, CA (MJP); Department of Sociology, University of California–Los Angeles, Los Angeles, CA (KC); Department of Technology, Operations, and Statistics, Stern School of Business, New York University, New York, NY (JT); Department of Medicine, University of California–San Francisco, San Francisco, CA (AF).
MD, MPH
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Keith Cox
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California–Los Angeles, Los Angeles, CA (DMT); Divisions of Geriatrics and Clinical Pharmacology, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California–San Francisco, San Francisco, CA (MB, JBS); Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, CA (MJP); Department of Sociology, University of California–Los Angeles, Los Angeles, CA (KC); Department of Technology, Operations, and Statistics, Stern School of Business, New York University, New York, NY (JT); Department of Medicine, University of California–San Francisco, San Francisco, CA (AF).
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Jon Turner
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California–Los Angeles, Los Angeles, CA (DMT); Divisions of Geriatrics and Clinical Pharmacology, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California–San Francisco, San Francisco, CA (MB, JBS); Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, CA (MJP); Department of Sociology, University of California–Los Angeles, Los Angeles, CA (KC); Department of Technology, Operations, and Statistics, Stern School of Business, New York University, New York, NY (JT); Department of Medicine, University of California–San Francisco, San Francisco, CA (AF).
PhD
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Alicia Fernandez
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California–Los Angeles, Los Angeles, CA (DMT); Divisions of Geriatrics and Clinical Pharmacology, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California–San Francisco, San Francisco, CA (MB, JBS); Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, CA (MJP); Department of Sociology, University of California–Los Angeles, Los Angeles, CA (KC); Department of Technology, Operations, and Statistics, Stern School of Business, New York University, New York, NY (JT); Department of Medicine, University of California–San Francisco, San Francisco, CA (AF).
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Janice B. Schwartz
From the Department of Family Medicine, David Geffen School of Medicine at UCLA, University of California–Los Angeles, Los Angeles, CA (DMT); Divisions of Geriatrics and Clinical Pharmacology, Departments of Medicine and Bioengineering and Therapeutic Sciences, University of California–San Francisco, San Francisco, CA (MB, JBS); Department of Epidemiology and Biostatistics, University of California–San Francisco, San Francisco, CA (MJP); Department of Sociology, University of California–Los Angeles, Los Angeles, CA (KC); Department of Technology, Operations, and Statistics, Stern School of Business, New York University, New York, NY (JT); Department of Medicine, University of California–San Francisco, San Francisco, CA (AF).
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Article Figures & Data

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    Figure 1.

    Framework describing major categories of information patients consider when newly prescribed a statin medication.

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    Table 1.

    Sample Focus Group Interview Guide

    • • Think back to why you didn’t get your statin medicine. What sorts of things kept you from getting it?

    • • Tell us about your interaction with your doctor when s/he prescribed the statin.

    • • What would have led you to fill the statin prescription when your doctor prescribed it?

    • • What might lead you to get the statin medicine in the future?

    • • Where do you get most of your information about statin medicines?

    • View popup
    Table 2.

    Focus Group Patient Characteristics (n = 61)

    Characteristicn (%) or Mean (SD)
    Age (years), mean (SD), range53.0 (10.2), 25–75
    Female, n (%)33 (54.1)
    Race/ethnicity, n (%)
     White20 (32.8)
     Black18 (29.5)
     Hispanic16 (26.2)
     Asian5 (8.2)
     Mixed race2 (3.3)
    History of diabetes, n (%)10 (16.4)
    History of heart attack, n (%)4 (6.6)
    History of stroke, n (%)0
    Prescription medications taken, mean (SD), range1.4 (1.8); 0–7
    Not taking any prescription medications, n (%)27 (44.3)
    • SD, standard deviation.

    • View popup
    Table 3.

    Sample Quotations Depicting the Subthemes Associated with Each Major Theme Influencing Primary Statin Nonadherence

    Major Themes and Associated SubthemesSample Quotes
    Desire for Alternative Treatments
     Lifestyle changes (diet and exercise)“I actually informed my doctor that I wasn’t gonna take it, but he can prescribe it to me first, but I wanted to go to changing my diet first to see if that would help.” [FG5:P1]
     Dietary supplements/alternative treatments“I think if you look up a bunch of your herbs, herbs that you can eat…that will also help. Natural herbs.” [FG6:P1]
    Risks
     Risks of statins worry patients
      Side effects and interactions“I don’t [want to] have liver and kidney problems, and muscle cramp[s], and all those crazy side effects.” [FG5:P4]
      Worsening of existing problems“Some of my friends and…me, I have asthma. They had took statin and they had more symptoms. It worsened their lung functions… yeah, it made it worse. Worsened their lungs.” [FG6:P3]
      Creating new medical problems“The last thing I wanted to do was to get type 2 diabetes while trying to lower my cholesterol. So it just seemed counterproductive.” [FG9:P1]
      Causing addiction or dependency“I didn’t know if this is something that you can get addicted to or something like that.” [FG6:P4]
     Perceptions of Good Health
      Too healthy or young to start a statin“Made me feel old, you know. I always thought statins would be for older people like, retirees, versus someone in their forties.” [FG3:P2]
      Good family history“My mother had the same lipid profile I have, and they wanted to put her on a statin. And I think she did it for a while, but—without it, though, she hit 93.” [FG1:P3]
      Cholesterol slightly high or not that high“I’m not that over the scale that I should have to be taking [a statin]… I’m only 8 points over.” [FG2:P4]
      Correctable reason for high cholesterol“My cholesterol was just over the normal, and I had lost my mother so I gained some weight…” [FG3:P5]
      High cholesterol is genetic“I heard my family mention that they also have the same issue with the high cholesterol. They were told that it was genetic and basically they were told that it didn’t matter if they took the medication…Basically, the medication wasn’t going to help. So I figure if it’s a genetic thing, why even take the medication?” [FG10:P1]
    Benefits—uncertainty about benefits
     Scientific evidence not definitive“The other key point from that [JAMA] article was that there was not as strong evidence that it really…that everybody would really need it even though it was being recommended under the new guidelines.” [FG7:P6]
     Risk calculator does not look at people as individuals“We’re being treated by a medical profession that sees us sort of as a statistic. I mean, statistically speaking, you have a 10% chance of having a cardiac event in the next blah-blah-blah. And we’re not all the same.” [FG1:P4]
     Link between cholesterol and CVD is uncertain“It’s not really clear how important is it to take statins, despite having a so-called high level of bad cholesterol.” [FG2:P1]
     Cholesterol cutoffs for treatment are arbitrary“I’m not going to take [a statin] for what could be just an arbitrary number.” [FG4:P5]
     Statins do not cure“We have to make changes in our life…Medication is not a cure. It’s just a Band Aid.” [FG4:P7]
    • CVD, Cardiovascular disease.

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The Journal of the American Board of Family     Medicine: 34 (1)
The Journal of the American Board of Family Medicine
Vol. 34, Issue 1
January/February 2021
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Perceptions of Patients with Primary Nonadherence to Statin Medications
Derjung M. Tarn, Maureen Barrientos, Mark J. Pletcher, Keith Cox, Jon Turner, Alicia Fernandez, Janice B. Schwartz
The Journal of the American Board of Family Medicine Jan 2021, 34 (1) 123-131; DOI: 10.3122/jabfm.2021.01.200262

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Perceptions of Patients with Primary Nonadherence to Statin Medications
Derjung M. Tarn, Maureen Barrientos, Mark J. Pletcher, Keith Cox, Jon Turner, Alicia Fernandez, Janice B. Schwartz
The Journal of the American Board of Family Medicine Jan 2021, 34 (1) 123-131; DOI: 10.3122/jabfm.2021.01.200262
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Keywords

  • Cardiovascular Diseases
  • Focus Groups
  • Hypercholesterolemia
  • Hyperlipidemias
  • Medication Adherence
  • Qualitative Research
  • Statins

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