title: Putting polypills into practice: challenges and lessons learned.
abstract: Regulatory approvals for cardiovascular polypills are increasing rapidly across more than 30 countries. The evidence clearly shows polypills improve adherence and cardiovascular disease risk factors for patients with indications for use of polypill components-ie, those with established cardiovascular disease or at high risk. However, the implementation of polypills into clinical practice has many challenges. The clinical trials literature provides insights into the clinical impact of a polypill strategy, including cost-effectiveness, safety of use, substantial improvement in adherence, and better risk factor control than usual care. Despite the clear need for such a strategy and the available clinical data backing up the use of the polypill in different patient populations, challenges to widespread implementation, such as an absence of government reimbursement and poor physician uptake (identified from on the ground experience in countries following commercial rollout), have greatly obstructed real-world implementation. Obtaining the full public health benefit of polypills will require education, advocacy, endorsement, and implementation by key global agencies such as WHO and national clinical bodies, as well as endorsement from governments.
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, Australia. Electronic address: rwebster@georgeinstitute.org.au.
authors.forename: Ruth
authors.initials: R
authors.lastname: Webster
authors.affiliation: National Center for Cardiovascular Research, Carlos III Institute of Health, Madrid, Spain; Monteprincipe University Hospital, HM Group, Madrid, Spain; CEU San Pablo School of Medicine, San Pablo, Madrid, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Castellano
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Oyere K
authors.initials: OK
authors.lastname: Onuma
mesh_terms: D001291:Attitude of Health Personnel; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D017277:Drug Approval; D004338:Drug Combinations; D004339:Drug Compounding; D018954:Drugs, Essential; D005544:Forecasting; D006801:Humans; D008019:Life Style; D010342:Patient Acceptance of Health Care; D010818:Practice Patterns, Physicians'; D011322:Primary Prevention; D011634:Public Health; D016032:Randomized Controlled Trials as Topic; D012051:Reimbursement Mechanisms; D055502:Secondary Prevention
chemical_list: D002317:Cardiovascular Agents; D004338:Drug Combinations; D018954:Drugs, Essential