The influence of physicians' guideline compliance on patients' statin adherence: a retrospective cohort study.
BACKGROUND
National cholesterol management guidelines recommend regular follow-up of patients and annual lipid evaluations to promote adherence to statin therapy.


OBJECTIVE
This study examined the relationship between primary care physicians' (PCPs') compliance with primary care guidelines and patients' adherence to statin therapy.


METHODS
A retrospective cohort study was conducted among statin users aged > or = 50 years who had an assigned PCP at a Veterans Affairs Medical Center. The dependent variable was statin adherence by patients over 24 months. Computerized pharmacy, laboratory, and medical records were used to measure PCPs' compliance with 4 recommendations in national cholesterol management guidelines: (1) lipid-lowering drug (LLD) initiation; (2) 8-week follow-up visit after an initial LLD prescription; (3) 6- or 12-month follow-up visit for established LLD users; and (4) annual lipid evaluation. Multilevel, multivariable regression models were used to estimate the effects of PCPs' guideline compliance on patients' adherence while controlling for patients' demographic characteristics, comorbid conditions, and pharmacotherapy factors.


RESULTS
The sample included 82 PCPs caring for 4707 patients. The mean statin adherence rate was 83.9%. An increase in the annual lipid evaluation rate resulted in an increase in patients' adherence (P = 0.037). Black race and higher statin dose negatively influenced patients' adherence (both, P < 0.001). The effects of PCPs' compliance rates were not homogeneous across race. Specifically, the 8-week follow-up visit rate after initial LLD prescription was significantly associated with improved statin adherence among the black subpopulation only.


CONCLUSIONS
Patients' adherence to statin therapy was influenced by their PCPs' compliance with cholesterol management guidelines. Efforts should be made to align PCPs' practice with published guidelines for optimal statin therapy, especially for vulnerable subpopulations of patients.
Campione
Joanne R
JR
Department of Health Policy and Administration, School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA. joanne_campione@unc.edu
Sleath
Betsy
B
Biddle
Andrea K
AK
Weinberger
Morris
M
D000368:Aged; D044383:Black People; D015331:Cohort Studies; D005006:Ethnicity; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010821:Physicians, Family; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors