Department of Research & Evaluation News

PASADENA, Calif. – Patients who do not fill their first prescription for cholesterol-lowering statins give a wide range of reasons for not doing so, including perceived concerns about the medication, a fear of side-effects and a decision to try lifestyle modifications instead of prescription medication, according to a Kaiser Permanente Southern California study published in The American Journal of Managed Care.

The cross-sectional study provides new information about qualitative evidence on primary nonadherence: situations where patients do not pick up their initial prescription. Researchers randomly selected and interviewed nearly 100 Kaiser Permanente Southern California members ages 24 and older with a new but unfilled statin prescription. Based on responses gathered from a semi-structured telephone interview, researchers reported that 63 percent of respondents did not fill their initial statin prescription because they had general concerns about taking the medication; 63 percent said they wanted to try lifestyle modifications rather than take a medication; and 53 percent reported a fear of the medication’s side-effects. 

If a patient is prescribed a statin medication, it’s important for their health that they take the medicine as prescribed by their health care professional. Understanding why some patients choose not to fill these prescriptions will help us create strategies to increase medication adherence and, hopefully, help more patients mitigate the health risks associated with high cholesterol, said study lead author Teresa Harrison, SM, of the Kaiser Permanente Southern California Department of Research & Evaluation. Our study found that patients’ reasons for primary nonadherence are varied, which suggests that individually tailored interventions could be helpful in increasing medication adherence. 

Researchers also found that one-third of the respondents had inadequate health literacy, with nearly 17 percent needing help reading medical material, 17 percent reporting problems learning about their medical condition, and 30 percent reporting a lack of confidence in completing health forms without assistance. 

Our findings also suggest that physicians need to engage patients in a discussion about their medications at the time of the initial prescription, using lay terminology, and perhaps educational materials such as handouts that cater to their low-literacy levels, said Harrison. It is also important that patients feel empowered to discuss any questions or concerns they have about their medications with their physicians at the time the medication is prescribed. 

According to the Centers for Disease Control and Prevention, high LDL cholesterol is a key risk factor for cardiovascular disease, the leading cause of death in the United States. Other key risk factors for heart disease include high blood pressure and smoking; nearly half of all Americans have at least one of these three risk factors. The CDC recommends that people with high blood pressure or high cholesterol eat a healthy diet, exercise, maintain a healthy weight and take their medications as prescribed.

This study is part of Kaiser Permanente’s ongoing research to understand the reasons for medication nonadherence. In November 2012, researchers at Kaiser Permanente Southern California found that patients newly prescribed a cholesterol-lowering medication were more likely to pick it up from the pharmacy if they received automated phone and mail reminders. And in 2011, a Kaiser Permanente study published in the Journal of General Internal Medicine found that people who receive medical care in an integrated health care system, with electronic health records linked to its own pharmacy, more often collect their new prescriptions for diabetes, cholesterol and high blood pressure medications than do people who receive care in a nonintegrated system. 

Kaiser Permanente can conduct transformational health research such as this study in part because it has the largest private electronic health system in the world. The organization’s integrated model and electronic health record system, Kaiser Permanente HealthConnect®, securely connects 9 million people, 611 medical offices and 37 hospitals, linking patients with their health care teams, their personal health information and the latest medical knowledge. It also connects Kaiser Permanente’s researcher scientists to one of the most extensive collections of longitudinal and medical data available, facilitating studies and important medical discoveries that shape the future of health and care delivery for patients and the medical community.

 This research was funded through a collaboration with Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, N.J. 

Other study authors included: Stephen F. Derose, MD, MS, Vicki Chiu, MS, and Kristi Reynolds, PhD, MPH, of the Kaiser Permanente Southern California Department of Research & Evaluation; T. Craig Cheetham, PharmD, MS, and Southida S. Vansomphone PharmD, of the Kaiser Permanente Southern California Pharmacy Analytical Service; Kelley Green, RN, PhD, of Kaiser Permanente Southern California Clinical Operations; Ronald D. Scott of Southern California Permanente Medical Group; and Kaan Tunceli, PhD, and Elizabeth Marrett, MPH, of Merck Sharp & Dohme Corp. 

About the Kaiser Permanente Southern California Department of Research & Evaluation 

The Department of Research & Evaluation (R & E) conducts high-quality, innovative research into disease etiology, prevention, treatment and care delivery. Investigators conduct epidemiology, health sciences and behavioral research as well as clinical trials. Areas of interest include diabetes and obesity, cancer, HIV/AIDS, cardiovascular disease, aging and cognition, pregnancy outcomes, women’s and children’s health, quality and safety, and pharmacoepidemiology. Located in Pasadena, Calif., the department focuses on translating research to practice quickly to benefit the health and lives of Kaiser Permanente Southern California members and the general population. Visit www.kp.org/research.  

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/newscenter.