Negative perceptions of statins lead to abandonment of initial Rx fill

Patients who fail to fill a new prescription for statin therapy have a number of reasons, including negative perceptions about the medication, a preference for lifestyle modifications, concerns about side effects, drug interactions, polypharmacy, and a perception that they do not need the drug, according to a study published by The American Journal of Managed Care.

In a cross-sectional telephone survey, researchers randomly interviewed approximately 100 Kaiser Permanente Southern California (KPSC) members who had not picked up a new statin therapy that had been prescribed 1 to 2 weeks earlier. KPSC members had been with the managed care organization for 12 months prior to the statin being ordered.

Study participants were contacted between June and July 2010 and were asked if they had picked up their statin therapy, the reason for not choosing a KPSC pharmacy, reasons for not picking up the prescription, use of nonprescription products for lowering cholesterol, and health literacy questions.

The respondents had a mean age of 59 years (range: 29-97 years) and 53% were male. About half were Caucasian, most had graduated from high school, and one third earned about $50,000 or less annually per household.  They had a mean low-density lipoprotein-cholesterol level of 151 mg/dL.

The most common reasons for not filling their statin prescriptions were:

• general concerns about taking the medication (63%)

• a decision to try lifestyle modifications first (63%)

• a fear of side effects (53%)

• perceived medication as unnecessary (39%)

• perceived condition as nonlife-threatening (35%)

In addition, 16% of the respondents were concerned about drug interactions and did not want to take more pills. Only 12% reported financial hardship. One-third of respondents reported taking nonprescription products to help lower their cholesterol levels, the authors wrote.

The researchers identified 33% of those surveyed with inadequate health literacy. About 17% reported problems associated with reading medical literature and the same percentage noted problems understanding their medical disorder, and 30% could not complete a health form independently.

“Our study found that patients’ reasons for primary nonadherence are varied, which suggests that individually tailored interventions could be helpful in increasing medication adherence,” said Teresa Harrison, of the KSPC Department of Research and Evaluation, the study’s lead author. “Physicians need to engage patients in a discussion about their medications at the time of the initial prescription, using lay terminology, and perhaps education materials such as handouts that cater to their low-literacy levels.”