Adherence to Statin Medication

Abstract

Statins are drugs that are used to lower the cholesterol levels in the body to prevent the occurrence of heart attacks, strokes and coronary artery disorders. Statins prescriptions are therefore important for patients who are suffering from heart problems and high levels of cholesterol within their bodies. The purpose of conducting this research is to determine the adherence to statin medication as well as the role of patient behaviour and characteristics.

The research will assess statin medications and what they are used for as well as what they do in the body. The study will also seek to determine what patient behaviours affect their adherence to statin medication. Methodology that was used for making research is based on studying relevant literature, and literature review is the key study tool for the offered topic. The period stated for the regarded researches is around two months, as lesser period do not offer the full research information for studying the problem of adherence.

Since the discussion chapter is mainly focused on the aspects of adherence to statin medication, and communication patterns among doctors and patients, the data collection tool also involved critical review of the methodologies and principles used by other researchers. Analysis part is based on the theoretic aspects of statin medication principles, and it should be emphasized that the actual importance of theoretic approach is the opportunity to create the research basis for further studies and discussions.

Introduction to the Study

Statin medication also known as HMG-CoA reductase inhibitors, are drugs that are used to reduce the levels of cholesterol within the human body by limiting the cholesterol production activities of the HMG-CoA reductase enzymes. Statins are also used to lower the low-density lipoprotein (LDL) cholesterol levels within the body. Apart from lowering the cholesterol levels in the body, statin drugs are also used to raise the high-density lipoprotein (HDL) cholesterol levels in the body to ensure that there is a balanced level of cholesterol.

LDL is referred to as bad cholesterol in the body as it affects the functions of major organs such as the liver and the heart while HDL is known as good cholesterol. Examples of statins used to lower the low-density lipoprotein cholesterol include atorvastatin, lovastatin and pravastatin (Sweetman 2009).

Statin medications have proved to be useful in reducing cardiovascular disorders as well as heart strokes and liver failure. They lower the LDL or bad cholesterol levels within the body by 1.8mmol/l or 70mg/dl which generally translates to a reduction of 60% of heart attack or cardiac arrest cases reported every year. Statins have been identified as the most suitable drugs that can be used in lowering the mortality rates of people that suffer from cardiovascular disorders.

They are also used in patients that have a high predisposition to heart diseases or coronary disorders (Law et al 2003). Statin medications are useful when it comes to dealing with people that have a high LDL cholesterol level in the bodies. High low-density lipoprotein levels have been identified by many medical practitioners to be the major causes of coronary artery disease (CAD) which leads to the hardening of the body’s arteries over a significant period of time. By lowering the high low-density lipoprotein cholesterol levels, statins help to reduce the risk of developing heart diseases and coronary disorders. They are also useful in reducing the risks of heart attacks as well as stroke related deaths in people that are suffering from coronary artery diseases (O’Connor et al 2005).

Statins were first developed in 1971 by a Japanese biochemist known as Akira Endo while conducting research to determine what drugs could be used to lower cholesterol levels within the human body. Endo created the statin drug based on research information that existed on the HMG-CoA reductase enzyme within the body’s liver.

The biochemist reasoned that certain microorganisms could be released by the reductase enzyme to reduce the levels of cholesterol within the body. Some of these microorganisms included mevastatin which is a molecule that is produced by Penicillium citrinum and mevalonate which is necessary in the maintenance of cell walls and cytoskeleton tissues within the human body. Endo’s research enabled him to create statins based on the HMG-CoA enzyme to reduce fat within the body (Endo 1992)

Like other forms of medication, statin drugs have various side effects that might prove harmful to the users of the medication. Some of the most common side effects of statins include muscle problems or muscle cramps, cognitive loss, sexual dysfunction, gastrointestinal problems, neuropathy and raised levels of liver enzyme production. Despite its effectiveness in reducing cholesterol levels within the body, statin medication poses these effects to people who are under statin medication.

Unfortunately, very few patients are aware of the danger that is posed by consuming statin medication. Although all statin drugs contain labels that warn patients of the adverse effects of the medication, the labels have been viewed by many medical practitioners to be inadequate and inconsistent since the warnings are written in very small print that is at times illegible (Steinberg 2007).

Every patient that has a prescription for statin medication should be made aware of the risks posed by taking these drugs. Patients need to be informed by their physicians of these adverse side effects posed by statins before they begin taking the drugs. Patients should be advised by their doctors to follow the instructions in the medication to the letter to ensure that they do not suffer the adverse effects of the medication. Statin medication should be administered to patients with not just proper information but also regular supervisions to ensure that the patients use the medication in the right way (Golomb et al 2008).

By properly adhering to the administration of the drugs, patients might be able to reduce the effects posed by statins when it comes to increasing liver enzyme production within the body as well as myositis and myopathy which increase the potential of the patient developing rhabdomyolysis, a condition that leads to the breakdown of skeletal muscle tissues. Providing patients with the relevant information will ensure that they use the statin medication in the right way to reduce any adverse side effects that are caused by statins. Doctors therefore have the important task of ensuring that there is effective communication when it comes to the use of statin medication with their patients when discussing their treatment plans (NCCPC 2010).

Background of the Study

The purpose of conducting this study is to determine the role of patient behaviour and information in the adherence to statin medication. Adherence to medication is an important subject especially when it comes to the adherence of drugs that have adverse side effects like statin medications. Patient behaviour is the action of the patient when it comes to adhering or conforming to medication or drugs prescribed by physicians.

The adherence to statin medication is an important topic for all healthcare providers as these medications have many side effects that might prove to be detrimental to patients. While cholesterol is important in the body, it needs to be maintained at a certain level to ensure that it does not pose any health problems to the patient. High cholesterol levels contribute to the development of atherosclerosis within the body where cholesterol containing plaques begins to develop within the body’s major arteries (Silva et al 2006).

Uses of Statin Treatments

The condition of atherosclerosis or plaque formation blocks the flow of blood in the body’s major arteries, reducing blood circulation which in turn affects the development of body tissues that are vital in the proper functioning of the body.

When the plaques rupture or become damaged, they lead to the formation of blood clots which block the flow of blood within the body’s arteries. Reduced levels of blood flow cause heart attacks, chest pains, coronary artery disorders, heart strokes and other conditions such as claudication which occurs in the legs. Statins are designed to reduce the levels of LDL cholesterol within the body which in turn reduces the formation of plaques and blood clots in the body’s arteries. Statins are also able to stabilize the plaques that exist in arteries by preventing them from rupturing and also reducing the occurrence of blood clots (Klein et al 2006).

Apart from treating blood clots and plaques that form in arteries, statins are also used in the treatment of atherosclerosis which is a complex condition that leads to the inflammation of the arterial walls as a result of high cholesterol levels within the body. Statins reduced the levels of inflammation within the body’s arteries reducing the chances of a person from developing atherosclerosis (Sasmaz and Korkmaz 2004).

Statins also reduce the chances of a patient from acquiring chest pains, heart strokes and claudication which arise as a result of atherosclerosis within the body. 35% individuals who suffer from heart problems do not usually suffer from high blood cholesterol levels. Some of their heart problems are therefore attributed to the presence of atherosclerosis within their body (Nissen et al 2006).

Adherence to Medication

Adherence is a commonly used term in the medical prescription of drugs as it means that the patient will comply with the doctor’s directions in taking the medication as well as follow the drug usage instructions. Adherence to medication is generally used to refer to the observance and conformity of drug usage but it might also be used to refer to the attendance of counselling sessions, the undertaking of self-directed physiotherapy exercises, and the taking care of a chronic wound or illness (Kedward and Dakin 2003).

In the determination of the rates of adherence, the aspects that are usually considered include the percentage of the prescribed doses and the specified period of time that the patient is meant to complete the dosage. Medical practitioners have further expounded on the definition of adherence to refer to the information that relates to dose taking of a prescribed number of pills in one day. Medical research has shown that the adherence rate to medication is higher in patients that are suffering from acute conditions such as AIDS or HIV.

While patients that suffer from acute conditions like HIV have a high level of medication adherence, patients that suffer from chronic conditions such as diabetes or asthma demonstrate a low adherence to medication (Osterberg and Blaschke 2005). According to a study conducted by Benner et al (2002), the number of patients who discontinued their intake of hydroxymethylglutaryl-coenzyme during the first three to six months of their medication was approximately half which demonstrated that chronic patients tended to have a low adherence to medication when compared to acute condition patients.

With regards to statin medication, many patients have been noted to stop taking their medication in less than six months after the statin medications have prescribed. According to clinical trials, the discontinuation of statin medications was calculated to be 6% to 30% where patients stopped adhering to their medication within the first few months of treatment. In the US, 50% of the patients discontinued their medication during the first six months of their treatment while 30% to 40% discontinued their treatment during the first one year of their treatment. This poor adherence to statin medication has mostly been attributed to economic factors, social considerations and psychological factors (Natarajan 2007).

Long Term Effects of Statin Medication

While the Federal Drug Association (FDA) has certified statins to be safe drugs in reducing cholesterol levels within the body, they have several adverse effects that affect individuals who have been taking the drugs for a prolonged period of time. The most common effects of statin medication are muscle cramps and muscle pain which might become potentially dangerous with the continued use of statin medication as muscle pain limits the ability of the patient to conduct basic functions such as walking, lifting of heaving objects and lifting of the hands. Muscle pain also leads to rhabdomyolysis, a condition that breaks down the muscles within the body leading to muscle weakness and pain (Schneeweiss et al 2007).

Another long term effect of statin medication is neuropathy which is a condition that leads to the malfunction of the peripheral nervous system that mainly controls the breathing functions of the heart. Neuropathy is also caused by the presence of poisonous chemicals within the body for a long duration of time. The prolonged use of statin medication by patients has been seen by most medical researchers to interfere with the normal functions of the body’s nervous system, making it hard for patients to breathe. Medical researchers and scientists have also noted that the build-up of satins within the body contributes to the development of neuropathy within the body (Blackburn et al 2005).

Apart from causing breathing problems, neuropathy which has been caused by the prolonged use of statin medications leads to muscle weakness which is a major sign of neuropathy. Patients who are under statin medication might not recognize this muscle weakness to be a symptom of neuropathy and they might confuse it with tiredness and ageing. Apart from muscle weakness, other signs and symptoms of neuropathy include burning pains in the muscle joints, numbness in the hands and legs, pricking sensations in the hands, legs and toes and an increased sensitivity to touch (Caspart et al 2005).

Another long term effect of neuropathy is memory loss which occurs in patients that have taken statin medications for a period of two years. Statins create an inability to concentrate well in patients and they also speed up the development of Alzheimer’s disease in patients that have been taking the statin medication for a long period of time. The memory loss is at times usually so severe that it lasts for between 6 to 12 hours in patients that are under statin medication.

This memory loss might at times become severe to the point the patient suffers from amnesia and delirium (Wright and Abrahamson 2007). A review of the cases analysed by the FDA showed that half of the patients on statins experienced some form of memory loss within the first 60 days of statin treatment. The review showed that patients who discontinued usage of the statin medication were able to revert to normal and the cases of memory loss were reduced considerably. Apart from memory loss, studies have also shown that patients experience mood swings and behavioural changes as a result of the continued use of statin medication (Perreault et al 2005).

Statin Intoxication

In terms of statin intoxication, various research studies have identified that several statin medications lead to conditions such as myopathies, renal failure and rhabdomyolysis. Studies conducted have showed that there are adverse manifestations of statin intoxication with the use of various statin medications such as lovastatin, fluvastatin and atorvastatin. When patients use a combination of these drugs to reduce cholesterol levels in their bodies, they are more than likely to develop liver failure as well as an elevation of transaminase enzymes within the body.

The continued use of different statin medications also increases the chances of a person developing hyperlipidaemia which in turn increases the chances of a person developing transaminase within their bodies. Statin intoxication or the use of several types of statin medications at once increases the incidence of a person developing eye cataracts, neoplasia and psychiatric problems (Chiang et al 2004). The diagrams below demonstrate the different types of statin medications that are used to control cholesterol levels in patients that suffer from coronary heart disorders and heart problems.

Statin containing medications.
Fig 1: Statin containing medications.

Effects of Proper Communication

Effective communication between the physician and the patient is a major contributing factor in the patient’s adherence to medication and treatment plans. The presence of effective communication between the healthcare provider and the patient will greatly affect the adherence of the patient to their medication (Campione et al 2005). The inability of doctors to issue clear communication treatment plans might contribute greatly to the patient’s non-adherence to the prescribed medication. Previous research and studies have shown that poor communication by the doctor contributes to the low rates of adherence to medication. One such study was conducted to investigate the level of doctor and patient communication when it came to patient adherence to medication (Anderson et al 2005).

The results of the study showed that 47% of the patients receiving at least one type of medication declined to ask their doctors any questions about their prescriptions. The patients failed to ask their doctors about the type of medication they were taking and also whether the medication had any adverse effects on their health. The study also revealed that doctors failed to explain the prescriptions properly to their patients which demonstrated that there was poor communication when it came to patient prescription medication.

This ineffective communication led to the patients discontinuing their medication because of poor instruction as well as side effects caused by the medication (Nakamura et al 2006). The study demonstrated that a lack of proper communication contributed greatly to low adherence rates to patient medication.

Effective communication ensures that patients are able to communicate their fears and feelings towards taking medication that might seem harmful to their health. Patients are able to communicate their experiences with prescription drugs and medication if there is effective communication between the doctor and the patient. While there have not been many studies conducted to determine whether effective communication affects patient adherence to medication, patients who receive minimal or no communication about their treatment regimes are more than likely to discontinue their treatment once they start experiencing adverse side effects. It therefore becomes imperative for doctors to maintain effective communication with their patients in terms of their treatment plans and medication (Higgins et al 2003).

Effective communication in the pharmacy is also important when patients are purchasing statin medication. Pharmacy policies are an important step in modulating the adherence behavior of patients as they are meant to ensure that patients understand how they are going to take their prescriptions to reduce the risk of heart problems. It is therefore important for pharmacists to maintain an effective communication link with their customers to ensure that they understand the importance of completing their statin prescriptions (Deddens and Petersen 2004). Effective communication by doctors and health care providers will therefore entail providing patients with the necessary medication and treatment for their illness as well as providing them with the necessary instructions on how to use this medication (Brookhart et al 2007).

Effective communication will also involve recommending the minimum amount of medication that a patient can take for their illness as well as making the dosage for medication more simple by creating a schedule that will enable the patient to determine when they should take their prescriptions. During the treatment process, doctors are expected to continually observe the progress of their patients as they go through the treatment to see whether they are taking the medication as prescribed and to determine whether there are any side effects that arise from consuming the prescriptions. Communication will also involve the doctors providing some recommendations that will be used by the patients in dealing with the side effects of the drugs in the event they occur (Brookhart et al 2007).

Aims and Purpose of the Research

The purpose of conducting this research will be to determine the adherence rates of patients to statin medication. This will involve determining the various factors that come into play when patients are under statin forms of medication and how these factors affect their adherence rates. The aim of conducting this research will be to determine what type of patient characteristics or behaviour are usually involved when adhering to statin medication and what role these characteristics play to dosage intake. Another aim of the study will be to determine why patients do not conform to doctors instructions when they are taking their medication. The research questions that will be answered in the discussion will involve:

  • What patient characteristics are used in the adherence to statin medication and how do these characteristics affect the treatment of cholesterol levels in patients that suffer from heart strokes and cardiovascular conditions?
  • How much information is given to patients by healthcare providers such as doctors, physicians and pharmacists when it comes to statin treatments?
  • Is there effective communication between doctors and their patients on the adverse effects that are caused by statin medications when they are discussing their treatment plans?

Methods

Data that is used for research is the adherence level of the patients, diet parameter, and life style habits. The number of papers studied is close to 40. Literature review is the key research tool that is intended to focus the research efforts on the specific aspect of the topic: adherence levels to statin, and usage of statin medication for patients with heart problem risks.

Research Methods

As identified in the introduction part of this research, the main aims of conducting this study are to determine the role of patient behaviour in the adherence to statin medication and how this behaviour affects the treatment of patients that suffer from heart problems and other cardiovascular disorders. The study also aims to determine whether there is any effective communication between doctors and their patients when it comes to statin medication and also if patients adhere to their statin medication.

Methodology

The type of the research that was applied involves randomized control over the medication principles and prescriptions in order to assess the adherence levels of the statin containing medicines. including atorvastatin, fluvastatin, simvastatin, lovastatin and pravastatin. Additionally, the patients were studied in accordance to several other parameters that involved health and lifestyle habits, diet parameters, age, gender, and medical prescriptions linked and not lined with cholesterol levels and heart problem risks.

Study Period and Outcome

The period selected for the study is two months. This will help to study all the cases, histories, health parameters, and undermine the likelihood of mistake in case descriptions and theoretic backgrounds. Additionally, medication principles, and duration of medicine taking will be studied for this period. Such a long term will be helpful for assessing patient behaviour, as well as their adherence level, depending on the health and treatment habits. (Wei et al 2002).

The outcomes of the research will depend on the study principles, and strategy of assessing the required data. Therefore, male and female data should be studied separately, however, the general data will be needed for outlining the key tendencies and statistical values. As for the matters of methodology effectiveness, it should be emphasized that this will be defined by the precision of the data retrieved, while patients will have an opportunity to refuse t participate in the study.

Critical findings and discussion

The papers that were mainly used for the research are focused on the matters of statin medications, as well as the principles of communication between doctor and a patient. In fact the aspect of communication was not paid sufficient attention, however, this was helpful for defining additional parameters of patients’ health, diet, and life style patterns.

Authors that were used for the study are given below. Theoretic background of the research is described by: Silva et al 2006, Klein et al 2006, Sasmaz and Korkmaz 2004, and Nissen et al 2006.

The practical principles of treatment, and intoxication aspects are described by Kedward and Dakin 2003, Osterberg and Blaschke 2005, Schneeweiss et al 2007, Blackburn et al 2005, Caspart et al 2005.

Anderson et al 2005, Nakamura et al 2006, Deddens and Petersen 2004, and Brookhart et al 2007 emphasize the matters of communications with the patients.

Patient adherence to statin Medication

Patient adherence to medication is important especially when it comes treating acute conditions such as coronary artery disorders, heart problems and liver failure. Heart attacks, liver and kidney failures have been identified to be the major causes of morbidity and mortality around the world. As discussed earlier, the major causes of these problems have been identified to be high levels of low-density lipoprotein (LDL) cholesterol levels within the body as well as high cholesterol levels within the body. Statins have been identified by most medical practitioners to be the most effective drugs in reducing the levels of cholesterol within the body. Statins are therefore the preferred drug of choice for patients who are suffering from high levels of cholesterol (Wei et al 2002).

In the general adherence to medication, the therapeutic effects of a drug usually depend on the ability of a patient to comply with the treatment plan that comes with the medication. Many doctors and physicians around the world provide their patients with medication instructions and treatment plans that they can use when taking their medication. These doctors expect their patients to follow these instructions to the letter to ensure that the drugs are effective in treating their patients. However most patients fail to adhere to the treatment plans prescribed by their doctors which makes the drug to be ineffective. Studies conducted in the recent past with relation to adherence to statin medication have shown that there is a low rate of drug adherence amongst patients who are under statin treatment (Benner et al 2005).

The effects of failing to complete statin treatments might lead to the return of heart problems and coronary heart problems which the statin treatment was meant to reduce. Patient behaviour therefore plays an important role when it comes to the adherence of statin medication. Patient behaviour is usually determined by various factors such as the patients understanding of the doctor’s instructions and their understanding of the prescription information. Patient behaviour is also determined by their belief that the statin medication will reduce heart problems. (Higgens et al 2003).

Studies on Patient Adherence to Statin Medication

The studies that have been conducted on the role of patient behaviour with regards to adherence to statin medication are mainly practical, while the actual importance of this research is to create a theoretic basis. One of these studies was conducted by Huser et al (2005) to assess the role of behaviour in adherence to statin medication. The studies revealed that despite well publicized guidelines on effective statin therapy, many patients did not finish their treatments which in the end exposed them to higher risks of cardiac events. The results of the study revealed that the adherence rates decreased from 56% to 35% in the first 9 months as the patients decreased their usage of statin medication. Another study was conducted to determine the impact of prescription size on the rate of adherence in statin treatments.

Batal et al (2007) conducted a study to determine whether the amount of prescription affected the adherence of patients to statin medication. The researchers analysed 3,386 patients who were under different types of statin medication in an inner city healthcare system. The factors that were considered in the study included the age of the patients, their gender, race and insurance status to determine whether any of these factors affected their adherence to statin medication.

The results of the study showed that 47.5% of the patients were adherent to their statin treatments when compared to 52.5% who were non-adherence to their statin medications. The univariate analysis of the results demonstrated that the insurance status of the patients as well as their obligation to co-pay did not have any correlation with their adherence to statin medication. The table below represents patient characteristics and the adherence to statin medication (Batal et al 2007). Table 1. Adherence levels

Total (n=3386) >80% Adherence (n=1610) <80% Adherence(n=1776) PValue
Age (years), mean (SD) 57.8(10.9) 58.7(10.7) 57.0(11.0) <0.001
Gender, n (%)
  • Female
  • Male
1932(57.1)
1454(42.9)
881(54.7)
729(45.3)
1051(59.2)
725(40.8)
0.009
Race, n (%)
  • Hispanic
  • White
  • Black
  • Other
1584(46.8)
919(27.1)
638(18.8)
245(7.2)
683(42.4)
515(32.0)
276(17.1)
136(8.5)
901(50.7)
404(22.8)
362(20.4)
109(6.1)
<0.001
Insurance, n (%)
  • Insured
  • Uninsured
989(29.2)
2397(70.8)
485(30.1)
1125(69.9)
504(28.4)
1272(71.6)
0.26
$0 co-pay, n (%) 2695(79.6) 1276(79.3) 1419(79.9) 0.64
No. of statin prescriptions, mean (SD) 8.0(5.2) 9.5(5.9) 6.6(4.1) <0.001
Days’ supply, n (%)
  • 30 days
  • 60days
833(24.6)
2553(75.4)
303(18.8)
1307(81.2)
530(29.8)
1246(70.2)
<0.001

The results of the study also showed that patients who had a larger prescription of statin medications had a greater adherence rate when compared to those who had a lower prescription of statin medication. Patients who had a 30-day fill to a 60-day fill had a higher adherence rate as they had more prescriptions to finish. The study revealed that the major reason for non-adherence to statin medication was because of forgetfulness to take the medication and if the patient has a 30 to 60-day fill, they might be able to have a higher adherence to the statin medication (Osterberg and Blaschke 2005).

The results also showed that patients who had insurance coverage were able to record a greater adherence to medication when compared to those that did not have any insurance coverage. This was because the cost of statin medication and prescriptions was lower for those that had insurance coverage (Batal et al 2007).

Various studies have been conducted on the role of patient behaviour when it comes to patient adherence to statin medication. One of these studies was conducted by Wei et al (2002) to investigate the adherence to statin treatments by patients who had suffered myocardial infarctions and to determine the effects of drug adherence to the recurrence of myocardial infarctions as well as to mortality and morbidity rates.

The study was conducted in Tayside in Scotland, UK through the use of medical databases that contained information of patients that had suffered from myocardial infarctions between 1985 and 1995. The total number of patients who were examined under the controlled clinical trial totalled 5,590 patients who had experienced their first MI complication between the identified periods (Wei et al 2002).

The results of the study showed that 13% of the 5590 patients had experienced at least one MI between January 1990 and November 1995 while 23% of the patients had died during the follow period of the study. Only 7% of the patients who had received statin medication for their myocardial infarctions had experienced a full recovery of their heart condition. There was a significant increase in statin medications after the first results of the study were published in 1994. The published studies showed that patients who were undergoing statin treatment had an 80% adherence to their medication. The diagram below demonstrates the characteristics of patients that have had recurrent myocardial infarctions and those that do not have any Myocardial infarctions recurrences (Wei et al 2002).

Patients receiving Statins.
Fig 2: Patients receiving Statins.

The results of a study conducted by Rifkin et al (2010) indicated that older patients were less than likely to be prescribed with statin medication when compared to younger patients. The results of the study also demonstrated that women of all ages had a higher adherence to statin medication when compared to men of the same age. Patients that lived in deprived areas recorded the highest level of statin medication adherence when compared to patients that lived in moderately deprived areas. The researchers based their analysis of the adherence to statin medication by patients on their gender, their age, deprivation category and death status (Rifkin et al 2010).

Another study was conducted by Natarajan et al (2007) to determine the adherence that patients had in taking statin medication in Halifax. Information for the study was obtained from a self-report survey that was sent to a hospital based practice and a community based hospital. 400 patients who were under statin medication and were 40 years or older were identified for the study within the population and the self-report survey was sent to these 400 patients and their families to determine their adherence to statin medication. The survey incorporated the use of a patient self-report survey that would measure the adherence of patients to statin medications.

330 out of the 400 patients that had been identified for the survey returned the self-report, the results of which showed that 18 out of the 330 patients had discontinued their statin medication. The results also showed that 17% out of the 330 patients were using non-statin medications to lower their cholesterol levels, 63% of the patients were identified to be highly adherent to their statin medications while 37% were either non adherent or moderately adherent to their statin treatment plans (Natarajan et al 2007).

The reasons proposed by the Shroufi and Powles (2010) for the high adherence rate by patients undertaking statin medication was mostly attributed to the insurance coverage that most of the patients in the study had. Other factors that contributed to the high levels of adherence to statin medication were the age of the patients where people older than 65 years were more than likely to record a high adherence to statin medication than people who were between the ages of 40 and 55. Patients who were taking more than 4 to 6 types of statin medications had a higher adherence than those who had between 2 to 4 types of statin medications (Shroufi and Powles 2010).

In terms of behaviour the study highlighted that patients who maintained a lifestyle of regular exercise and a healthy balanced diet were able to record high adherence to statin medications when compared to those patients who had a poor or unbalanced diet. The beliefs of the patient’s also played an important part in their statin medication adherence rates where in the study, patients who believed that that statins reduced their risk of developing heart attacks recorded a high adherence rate when compared to those who did not belief that statin medication reduced their heart problems (Jackevicius and Mamdani 2002).

Critical Review

The control of the trial results revealed that patients with higher numbers of satin prescriptions had higher adherence level to it. Therefore, it should be stated that poor adherence is the matter of properly grounded prescription, as regardless of the general treatment aims, there is a need to consider the previous or parallel prescriptions of each particular patient. Additionally, patients who did not follow the prescriptions, are subjected to a higher risk of heart attack. Therefore, considering the adherence goal of 80%, the data that was used for research may be regarded as the control level for defining the adherence level of statin therapy principles. The adherence goal also ensured that the proper measurement of statin adherence was achieved within a controlled trial environment (Yilmaz et al 2004).

The research involves analysis of the patients’ data, and information associated with statin therapies and adherences, nevertheless, this can not be full without proper consideration of combination with other medicines, and components that may interact with statin. Hence, as it is stated by Sasmaz and Korkmaz (2004), combining statin with fibrate, the risk of rhabdomyolysis increases. Therefore, physicians perform proper monitoring the level of liver enzymes. Moreover, it is impossible to consider the consumption of grapefruits by patients. As it is emphasized by Sweetman (2009), grapefruit juice violates the metabolism of statins, thus, the entire effectiveness of the therapy is decreased.

The meta analysis that is performed in the paper revealed that higher dosage of statin and LDL helped to reduce the cholesterol level in the patients, however, the overall risk of heart problem development is not assessed properly. The stroke development is 0.90 when a 1.0mmol/l reduction in LDL cholesterol was reduced through the use of various statin medications and treatments. Simvastatin prescriptions of 40mg per day as well as lovastatin and atorvastatin prescriptions of 10mg per day taken by the patients were able to lower their low-density lipoprotein cholesterol levels to 37% during the randomised control trial.

In accordance with the study results, the age dependence of the stating adherence levels, it is stated that patients aged 65 and over had higher adherence in comparison with those who were under 65. Additionally women had higher chances to develop high adherence levels in comparison with men. However, statin is not prescribed to women frequently, moreover, it is not recommended to prescribe statins to women after 70 as a primary measure for decreasing heart problem risks. This is based on studies and research work that has demonstrated that men are more than likely to suffer from heart problems and heart attacks when compared to women (Munger et al 2007).

The results of the study also showed that people from the more deprived areas had a higher adherence rate that the people from the less deprived areas. This high adherence rate was mostly attributed to the high costs of medication as well as treatment for heart problems. The use of the socioeconomic deprivation aspect in the study was necessary to determine the adherence rates of patients who came from different economic backgrounds. In the light of this fact, it should be emphasized that the actual importance of the satin medication adherence study is based on the principles of assessing risk factors and studying the effects of statin usage for decreasing the risk of coronary heart decreases.

In comparison with other studies, it should be stated that the paper involves the factor of personal suitability to statins. Hence, the adherence level is defined by the personal acceptance or non-acceptance of this component. In the light of this statement, the study of adherence level should be understood as the process of comparing health parameters of every patient, and analyzing the problem in the context of heart problem risk analysis. Therefore, sex, age, history of heart problems, treatment regimes, parallel medicine taking, as well as diet should be regarded as the key study parameters for analyzing the adherence level of every particular patient.

Considering the opportunity of various research methods, it should be emphasized that methods that may be used for these researches are varying in accordance with the aims and principles of the research performed. The studies selected for the literature review involved different methods, which involved semi-structured questionnaire, interview, and oral administration of statin medication with monitoring and so on. Each method presupposes particular advantages and drawbacks, and it should be stated that combination of these methods helped to create the most effective research basis for each case.

Therefore, semi structured questionnaire is used by few authors, such as O’Connor et al (2005), Natarajan et al. (2006) used these methods for defining the key health parameters of the patients. Interviews are used by every researcher who focused on the aspect of communication, and life style patterns. These two methods are not effective for studying the medical principles of treating patients, as these data is mainly recorded in data sheets, cases, and histories.

Oral administration with monitoring is the optimized variant for researching communication and medical practices altogether, nevertheless, it is impossible to focus on a particular research aspect.

Considering the methods used for arranging research, it should be emphasized that the actual importance of the literature review is associated with the matters of assessing the results of previous researches. The positive moments of this method are linked with the opportunity to study cases of various patients, and assess therapies based on wide range of health characteristics. The negative moment is that few researchers focus on the matters of communication, assessing life style and other patterns.

The size of the population used for the study is 164 short-term patients that were regarded in the reviewed researches. This amount helped to study the details of the problem, define the key aspects of the problem in general, as well as the directions for further studies. Therefore, the outcomes of the study involve the creation of a properly structured research background for deeper study of statin medication, and adherence related problems. The personal opinion is based on the statement that the research is quite full, as it involves numerous aspects of the research problem, as well as health parameters that are not studied by most researchers that are involved into the problem of statin medication.

Conclusion

The purpose of this study has been to examine the aspect of patient behaviour when it comes to the adherence of statin medication. The various characteristics of patients such as their age, gender and socio economic status were used to determine their adherence rates to statin medication. The results demonstrated that these characteristics affected the adherence rates of patients to their statin medications which mean that patient behaviour and characteristics played an important part in influencing the adherence of patients to their statin medication.

As for the additional aspects of the research, it should be emphasized that communication strategies and processes that were used by doctors are associated with the matters of doctor’s experience, and they differ in each particular case. Additionally, few researchers have focused on communication. Therefore, the data used for this research is based on the principles of proper assessment of theoretic background, offered by other researchers.

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