Predictors, barriers, and facilitators of lipid-lowering medication use among African Americans in a primary care clinic.
BACKGROUND
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 CHD were significantly more likely to have a lipid-lowering medication prescription than those without, adjusted prevalence ratio 2.56 (95% CI, 1.76-3.74) for hypertension and 1.70 (95% CI, 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.
Schwartz
Kendra L
KL
Department of Family Medicine, Wayne State University School of Medicine, Detroit, Michigan 48201, USA. kensch@med.wayne.edu
Dailey
Rhonda
R
Bartoces
Monina
M
Binienda
Juliann
J
Archer
Carolyn
C
Neale
Anne Victoria
AV
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000368:Aged; D016001:Confidence Intervals; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy* / Q000208:ethnology; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence / Q000208:ethnology / Q000523:psychology*; D008824:Michigan; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D055815:Young Adult; D016903:Drug Monitoring
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents