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PCPs neglect some patients’ medication concerns

Although patients often have concerns about side effects of secondary prevention medications, their physicians do not always address them, according to findings recently published in Family Practice.

“Evidence shows that many of the difficulties stroke survivors have adhering to secondary prevention strategies are potentially preventable with tailored information, monitoring and follow-up by primary health care professionals,” Nkeonye J Izuka, MSc, MBBS, of the Centre for Primary Care and Public Health in London, and colleagues wrote. “Appropriate interaction between patient and health professional is recognized as becoming an increasingly important factor and its quality correlating with the success of self-management, adherence, satisfaction and health outcomes.”

Researchers analyzed 43 online discussion threads involving 50 participants that discussed secondary prevention medication terms, general practitioners and any associated replies in a forum hosted by the Stroke Association, an independent nonprofit organization based in London that raises funds for research, support and advocacy. The chats studied took place over 7 years.

Izuka and colleagues wrote that patients either followed the advice they were given, did not follow the advice, or they asked other participants for feedback. Of the patients who followed the advice, they felt reassured, happy because the side effects were tolerable, or still retained anxiety. Those patients who did not follow the advice admitted to periodic adherence to medications or stopped them all together.

“These data suggest that side effects of secondary prevention medications, and statins in particular, cause anxiety and resentment in some patients, and their concerns are not always addressed by practitioners,” researchers wrote. “Patients admitted suboptimal adherence or stopping taking statins after one or two practitioners’ consultations. Educating patients in advance about side effects and the potential need of several attempts to find suitable treatment, in addition to offering a follow-up after medication changes might be considered, in particular for statins.”

One of the researchers said the study was an eye-opener that led to a change in her practices.

“Given the variety of cholesterol lowering treatments and possible approaches to manage statin-intolerant patients, I was surprised to see that patients seemingly lost hope after only one or two contacts with their [general practitioner] unaware that a better regimen may have been available or that their [general practitioner] would have been able to carry out another change in medication,” Anna De Simoni, BS, MB, PhD, of the Centre for Primary Care and Public Health, said in a press release. “In my practice, I am now advising patients that multiple treatment options are available, and several attempts may be required before a suitable treatment is found. It is also important to proactively invite them to seek help if side effects are experienced and don't improve.”

Researchers also suggested that clinicians follow up with patients, perhaps with a phone call, after changes in treatment or after providing advice on continuing with secondary prevention medications, to settle many of the patients’ issues. They also noted that good, trusting relationships with their physicians may help patients feel confident enough to keep sharing the problems they are having with medication nonadherence or adverse events. – by Janel Miller

Disclosure: The researchers report no relevant financial disclosures.