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How do prescribing doctors anticipate the effect of statins?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Socialmedicinsk epidemiologi)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine. (Socialmedicinsk epidemiologi)
2011 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 17, no 3, 420-428 p.Article in journal (Refereed) Published
Abstract [en]

Objectives:

Statins are a lipid-lowering treatment, prescribed frequently to prevent cardiovascular events. The objective of this study was to explore how doctors anticipate the effect of statins and what factors are associated with their willingness to initiate treatment.

Methods:

A total of 330 Swedish cardiologists, internists and general practitioners were asked to consider two hypothetical patient cases, one with and one without previous coronary heart disease. Based on these cases, the respondents answered questions about their willingness to initiate treatment and what effects they might expect. The expectation of effect was assessed in two ways: (1) the absolute risk reduction of myocardial infarction in 1000 patients treated with statins for 5 years; and (2) statins' average effect on increased life expectancy. The doctors' beliefs about absolute risk reduction were compared with results from clinical trials.

Results:

Most doctors had a suboptimal expectation about absolute risk reduction; only about one-third had expectations in the range supported by evidence-based data. There were different views about statins' ability to prolong life: that is, average gain in life expectancy due to treatment was believed to be 2 years in the primary patient case, and 3 years in the second patient case. The doctors' beliefs about statins' ability to prolong life were associated significantly with their willingness to initiate treatment.

Conclusion:

The overall results imply that doctors have varying and suboptimal understanding of the effect of statins. This may inhibit the goal of integrating clinical research into clinical practice.

Place, publisher, year, edition, pages
2011. Vol. 17, no 3, 420-428 p.
Keyword [en]
absolute risk reduction, HMG-CoA reductase inhibitors, doctors, prevention. statins, treatment expectations
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
URN: urn:nbn:se:uu:diva-122139DOI: 10.1111/j.1365-2753.2010.01442.xISI: 000290581000002PubMedID: 20545813OAI: oai:DiVA.org:uu-122139DiVA: diva2:308495
Available from: 2010-04-06 Created: 2010-04-06 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Power of the Pill: Views about Cardiovascular Risk and the Risk-reducing Effect of Statins
Open this publication in new window or tab >>Power of the Pill: Views about Cardiovascular Risk and the Risk-reducing Effect of Statins
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Medical treatments with statins are prescribed to patients with increased risk of cardiovascular events. The benefits from statin treatment are well documented in clinical trials, but long-term adherence in patients is low, indicating that patients have an uncertainty about the necessity and benefits of treatment.

The aims of this thesis were to investigate how patients and doctors view different aspects of statin treatment. Further aims were to investigate if the cardiovascular risk level in patients affects their views about different aspects of statin treatment. Yet further aims were to compare health behaviours and views about risk factors in patients using statins to a non-treated population.

Data was obtained from patients (n = 829), doctors (n = 330) and a population sample (n = 720) using postal questionnaires. Views about the effect of statin treatment were assessed in different ways for patients and doctors. Patients based their assessments on their own situation, and doctors’ treatment decisions and assessments of anticipated effect of treatment were based on two hypothetical patient cases.

The results indicate that patients greatly overestimate the general effect of statins, compared to efficacy results reported from clinical trials. Patients’ previous coronary heart disease or high overall risk were factors not associated with their views and expectations of treatment effect. Statin users with an internally perceived health control and patients satisfied with their doctor’s treatment explanation reported higher beliefs in treatment necessity and benefits. Statin users reported having better health behaviours and generally rated risk factors as more important than the non-treated population. Doctors had suboptimal understanding of the number of patients expected to benefit following five years of statin treatment and had a varying understanding of statins’ ability to prolong life.

Overall the results illustrate that patients and doctors have different perspectives and views of the benefits from statin treatment which puts emphasis on how statin treatment is discussed in the clinical setting.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 85 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 556
Keyword
Statins, lipid-lowering drugs, cholesterol, treatment expectations, beliefs, adherence, health behaviour
National Category
Public Health, Global Health, Social Medicine and Epidemiology Social and Clinical Pharmacy Family Medicine Public Health, Global Health, Social Medicine and Epidemiology Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Social Medicine
Identifiers
urn:nbn:se:uu:diva-121776 (URN)978-91-554-7793-6 (ISBN)
Public defence
2010-05-21, Enghoffsalen, Ingång 50, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2010-04-29 Created: 2010-03-30 Last updated: 2010-04-29Bibliographically approved

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Lytsy, PerBurell, GunillaWesterling, Ragnar

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