title: Apparent discontinuation rates in patients prescribed lipid-lowering drugs.
abstract: OBJECTIVE
  To evaluate apparent discontinuation rates in patients newly prescribed lipid-lowering drugs.
  
  
  METHODS
  A prospective survey of 12 months' dispensing data in 138 community pharmacies across metropolitan Sydney.
  
  
  METHODS
  610 adults (49% men) with a mean age of 58 years; 91% of prescriptions were from general practitioners; prescribed drugs were simvastatin (54%), pravastatin (31%) and gemfibrozil (15%).
  
  
  METHODS
  The number of patients failing to collect prescription refills.
  
  
  RESULTS
  60% of patients (95% confidence interval [CI], 56%-64%) apparently discontinued their medication over 12 months. Half of the apparent discontinuations occurred within three months and a quarter within one month of starting treatment. The predominant reasons for discontinuation were: patient unconvinced about need for treatment (32%), poor efficacy (32%) and adverse events (7%). Only half of those experiencing poor efficacy were switched to another drug. The relative risk (RR) of discontinuation was lower in older patients (age 65+ v. <50 years: RR 0.66; 95% CI 0.47-0.93) and in those using other cardiovascular drugs (RR 0.69; CI 0.56-0.86), but was increased in those showing early evidence of poor compliance (RR 1.77; CI 1.33-2.35). Discontinuation appeared to be unrelated to sex, the source of the prescription (general practitioner or specialist), past use of lipid-lowering drugs or the cost of medication.
  
  
  CONCLUSIONS
  High apparent discontinuation rates with lipid-lowering drugs suggest significant wastage of resources in treatments that are initiated but not continued and a lost opportunity for heart disease prevention. Many patients appear to discontinue therapy for illogical reasons and this may be amenable to intervention.
authors.affiliation: University of New South Wales Lipid Research Department, St Vincent's Hospital, Sydney.
authors.forename: L A
authors.initials: LA
authors.lastname: Simons
authors.forename: G
authors.initials: G
authors.lastname: Levis
authors.forename: J
authors.initials: J
authors.lastname: Simons
mesh_terms: D000368:Aged; D003157:Community Pharmacy Services; D004363:Drug Utilization; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009517:New South Wales; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011358:Product Surveillance, Postmarketing; D011446:Prospective Studies; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data; D014504:Urban Health
chemical_list: D000960:Hypolipidemic Agents