title: Patients' and providers' perspectives of a polypill strategy to improve cardiovascular prevention in Australian primary health care: a qualitative study set within a pragmatic randomized, controlled trial.
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.
  
  
  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.
  
  
  BACKGROUND
  URL: http://www.anzctr.org.au.
  12608000583347.
authors.affiliation: 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.
authors.forename: Hueiming
authors.initials: H
authors.lastname: Liu
authors.affiliation: 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.).
authors.forename: Luciana
authors.initials: L
authors.lastname: Massi
authors.affiliation: 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.).
authors.forename: Tracey-Lea
authors.initials: TL
authors.lastname: Laba
authors.affiliation: 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.).
authors.forename: David
authors.initials: D
authors.lastname: Peiris
authors.affiliation: 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.).
authors.forename: Tim
authors.initials: T
authors.lastname: Usherwood
authors.affiliation: 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.).
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
authors.affiliation: 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.).
authors.forename: Alan
authors.initials: A
authors.lastname: Cass
authors.affiliation: 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.).
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Eades
authors.affiliation: 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.).
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern
authors.affiliation: 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.).
authors.forename: Noel
authors.initials: N
authors.lastname: Hayman
authors.affiliation: 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.).
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
authors.affiliation: 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.).
authors.forename: Jo-anne
authors.initials: JA
authors.lastname: Brien
authors.affiliation: 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.).
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
mesh_terms: D002317:Cardiovascular Agents / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004338:Drug Combinations; D006801:Humans; D007407:Interviews as Topic; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care
chemical_list: D002317:Cardiovascular Agents; D004338:Drug Combinations
keywords: adherence; qualitative research