Improving long-term adherence to statin therapy: a qualitative study of GPs' experiences in primary care

Background Statins substantially reduce the risk of cardiovascular disease when taken regularly. Though statins are generally well tolerated, current studies show that one-third of patients discontinue use of statins within 2 years. A qualitative approach may improve the understanding of attitudes and behaviours towards statins, the mechanisms related to discontinuation, and how they are managed in primary care. Aim To identify factors related to statin discontinuation and approaches for long-term statin adherence. Design and setting A qualitative study of German GPs' experiences with statin therapy in rural and urban settings in primary care. Method Semi-structured interviews (n = 16) with purposefully recruited GPs were recorded, transcribed, and analysed using qualitative content analysis. Results Sociodemographic patient factors, the nocebo effect, patient attitudes towards primary prevention, and negative media coverage had significant impacts on statin therapy according to GPs. To overcome these barriers, GPs described useful strategies combining patient motivation and education with person-centred care. GPs used computer programs for individual risk-benefit analyses in the context of shared decision making. They encouraged patients with strong concerns or perceived side effects to continue therapy with a modified medication regimen combined with individual therapy goals. Conclusion GPs should be aware of barriers to statin therapy and useful approaches to overcome them. They could be supported by guideline recommendations that are more closely aligned to primary care as well as comprehensible patient information about lipid-lowering therapy. Future studies, exploring patients' specific needs and involving them in improving adherence behaviour, are recommended.