Hueiming Liu1, Luciana Massi2, Tracey-Lea Laba2, David Peiris2, Tim Usherwood2, Anushka Patel2, Alan Cass2, Anne-Marie Eades2, Julie Redfern2, Noel Hayman2, Kirsten Howard2, Jo-anne Brien2, Stephen Jan2. 1. From The George Institute for Global Health, University of Sydney (H.L., L.M., T.-L.L., D.P., A.P., A.-M.E., J.R., S.J.); Department of General Practice, Western Clinical School, University of Sydney (T.U.); Menzies School of Health Research, Charles Darwin University (A.C.); Inala Indigenous Health Service; School of Public Health, University of Sydney (N.H., K.H.); and Faculty of Pharmacy, University of Sydney (J.-a.B.). hliu@georgeinstitute.org.au. 2. From The George Institute for Global Health, University of Sydney (H.L., L.M., T.-L.L., D.P., A.P., A.-M.E., J.R., S.J.); Department of General Practice, Western Clinical School, University of Sydney (T.U.); Menzies School of Health Research, Charles Darwin University (A.C.); Inala Indigenous Health Service; School of Public Health, University of Sydney (N.H., K.H.); and Faculty of Pharmacy, University of Sydney (J.-a.B.).
Abstract
BACKGROUND: This study explores health provider and patient attitudes toward the use of a cardiovascular polypill as a health service strategy to improve cardiovascular prevention. METHODS AND RESULTS: In-depth, semistructured interviews (n=94) were conducted with health providers and patients from Australian general practice, Aboriginal community-controlled and government-run Indigenous Health Services participating in a pragmatic randomized controlled trial evaluating a polypill-based strategy for high-risk primary and secondary cardiovascular disease prevention. Interview topics included polypill strategy acceptability, factors affecting adherence, and trial implementation. Transcribed interview data were analyzed thematically and interpretively. Polypill patients commented frequently on cost-savings, ease, and convenience of a daily-dosing pill. Most providers considered a polypill strategy to facilitate improved patient medication use. Indigenous Health Services providers and indigenous patients thought the strategy acceptable and beneficial for indigenous patients given the high disease burden. Providers noted the inflexibility of the fixed dose regimen, with dosages sometimes inappropriate for patients with complex management considerations. Future polypill formulations with varied strengths and classes of medications may overcome this barrier. Many providers suggested the polypill strategy, in its current formulations, might be more suited to high-risk primary prevention patients. CONCLUSIONS: The polypill strategy was generally acceptable to patients and providers in cardiovascular prevention. Limitations to provider acceptability of this particular polypill were revealed, as was a perception it might be more suitable for high-risk primary prevention patients, though future combinations could facilitate its use in secondary prevention. Participants suggested a polypill-based strategy as particularly appropriate for lowering the high cardiovascular burden in indigenous populations. CLINICAL TRIAL REGISTRATION: URL: http://www.anzctr.org.au. ANZCTRN: 12608000583347.
RCT Entities:
BACKGROUND: This study explores health provider and patient attitudes toward the use of a cardiovascular polypill as a health service strategy to improve cardiovascular prevention. METHODS AND RESULTS: In-depth, semistructured interviews (n=94) were conducted with health providers and patients from Australian general practice, Aboriginal community-controlled and government-run Indigenous Health Services participating in a pragmatic randomized controlled trial evaluating a polypill-based strategy for high-risk primary and secondary cardiovascular disease prevention. Interview topics included polypill strategy acceptability, factors affecting adherence, and trial implementation. Transcribed interview data were analyzed thematically and interpretively. Polypill patients commented frequently on cost-savings, ease, and convenience of a daily-dosing pill. Most providers considered a polypill strategy to facilitate improved patient medication use. Indigenous Health Services providers and indigenous patients thought the strategy acceptable and beneficial for indigenous patients given the high disease burden. Providers noted the inflexibility of the fixed dose regimen, with dosages sometimes inappropriate for patients with complex management considerations. Future polypill formulations with varied strengths and classes of medications may overcome this barrier. Many providers suggested the polypill strategy, in its current formulations, might be more suited to high-risk primary prevention patients. CONCLUSIONS: The polypill strategy was generally acceptable to patients and providers in cardiovascular prevention. Limitations to provider acceptability of this particular polypill were revealed, as was a perception it might be more suitable for high-risk primary prevention patients, though future combinations could facilitate its use in secondary prevention. Participants suggested a polypill-based strategy as particularly appropriate for lowering the high cardiovascular burden in indigenous populations. CLINICAL TRIAL REGISTRATION: URL: http://www.anzctr.org.au. ANZCTRN: 12608000583347.
Authors: Ehete Bahiru; Angharad N de Cates; Matthew Rb Farr; Morag C Jarvis; Mohan Palla; Karen Rees; Shah Ebrahim; Mark D Huffman Journal: Cochrane Database Syst Rev Date: 2017-03-06
Authors: Aaron S Kesselheim; Sarah A McGraw; Sara Z Dejene; Paula Rausch; Gerald J Dal Pan; Brian M Lappin; Esther H Zhou; Jerry Avorn; Eric G Campbell Journal: Drug Saf Date: 2017-06 Impact factor: 5.606
Authors: Jens Lehmann; David Riedl; Monika Sztankay; Christian Boehme; Julian Fischnaller; Stefan Kiechl; Bernhard Holzner; Michael Knoflach; Gerhard Rumpold Journal: Eur J Neurol Date: 2021-09-09 Impact factor: 6.288