Predictors, Barriers, and Facilitators of Lipid-Lowering Medication Use Among African Americans in a Primary Care Clinic

Introduction: Hypercholesterolemic African Americans are less likely than white Americans to be taking lipid-lowering medications, yet they suffer disproportionately from coronary heart disease (CHD). Methods: Through medical record abstraction and focus groups with patients and physicians, we sought a better understanding of the predictors, barriers, and facilitators to lipid-lowering medication use in a Detroit primary care clinic. Stepwise regression analysis included 634 African American patients with abnormal cholesterol values (n = 575) or currently prescribed a lipid-lowering medication (n = 59). Focus group transcripts were analyzed with a framework approach. Results: Overall 174 (30.3%) of hypercholesterolemic African Americans were prescribed a lipid-lowering medication. Patients with hypertension or CHID were significantly more likely to have a lipid-lowering medication prescription than those without, adjusted prevalence ratio 2.56 (95% Cl, 1.76-3.74) for hypertension and 1.70 (95% Cl, 1.45-2.00) for CHD. Focus groups revealed 2 barriers to lipid-lowering medication use named by both physicians (n = 12) and patients (n = 23): cost and forgetting to take medication, often because of lack of symptoms. Conclusions: Physicians and patients suggested better education by physicians and at the community level to improve lipid-lowering medication use. Simple and direct patient-physician discussions emphasizing long-term benefits are recommended.