Physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention: a qualitative methods study
Objectives In the context of limited evidence on statin use in primary cardiovascular prevention in older adults, we assessed physician perspectives on decision-making about statin continuation or discontinuation in this population.Design Qualitative descriptive approach including four focus groups....
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BMJ Publishing Group
2024-10-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/14/10/e085569.full |
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| author | Claudio Schneider Nicolas Rodondi Carole Elodie Aubert Laureline Brunner Andreas Marti Samuel Zbinden |
| author_facet | Claudio Schneider Nicolas Rodondi Carole Elodie Aubert Laureline Brunner Andreas Marti Samuel Zbinden |
| author_sort | Claudio Schneider |
| collection | DOAJ |
| description | Objectives In the context of limited evidence on statin use in primary cardiovascular prevention in older adults, we assessed physician perspectives on decision-making about statin continuation or discontinuation in this population.Design Qualitative descriptive approach including four focus groups. Inductive and deductive thematic analysis.Setting and participants 18 physicians including two neurologists, three cardiologists, seven hospital internists and six primary care providers (PCPs) recruited at a hospital and primary care practices in the area of Bern in Switzerland.Results Concerning knowledge about statins in older adults, physicians reported defining if a patient is treated for primary or secondary prevention as challenging and that lack of evidence makes the decision to continue or discontinue the statin difficult. In terms of beliefs, fear of a possible rebound effect after statin discontinuation was reported. Regarding decision-making, physicians mentioned that statin discontinuation or continuation should be a shared decision between the patient and the physician. Concerning the professional role, environmental context and resources, the PCP office was identified as the ideal setting to discuss discontinuation, as all necessary information is available and PCPs have a longer relationship with the patients, thus facilitating a shared decision. Discontinuation of a chronic medication was perceived as difficult in general. Furthermore, PCPs noticed a possible negative impact on patient–physician relationship as some patients felt not being worth it, given up or undertreated if the statin was discontinued.Conclusions This study highlights the challenges of statin continuation and discontinuation in older patients and the crucial role of PCPs in situations with unclear evidence for a medication, where shared decision-making between physicians and patients is important. More evidence forming the background for a decision aid would be helpful. |
| format | Article |
| id | doaj-art-1ca47d0ec2534ef682ffa5f3e93b631a |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-1ca47d0ec2534ef682ffa5f3e93b631a2025-08-20T01:47:28ZengBMJ Publishing GroupBMJ Open2044-60552024-10-01141010.1136/bmjopen-2024-085569Physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention: a qualitative methods studyClaudio Schneider0Nicolas Rodondi1Carole Elodie Aubert2Laureline Brunner3Andreas Marti4Samuel Zbinden5Department of Emergency Medicine & Department of General Internal Medicine, Inselspital University Hospital Bern, Bern, SwitzerlandInstitute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandDepartment of General Internal Medicine, Inselspital University Hospital Bern, Bern, SwitzerlandInstitute of Primary Health Care (BIHAM), University of Bern, Bern, SwitzerlandDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandDepartment of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, SwitzerlandObjectives In the context of limited evidence on statin use in primary cardiovascular prevention in older adults, we assessed physician perspectives on decision-making about statin continuation or discontinuation in this population.Design Qualitative descriptive approach including four focus groups. Inductive and deductive thematic analysis.Setting and participants 18 physicians including two neurologists, three cardiologists, seven hospital internists and six primary care providers (PCPs) recruited at a hospital and primary care practices in the area of Bern in Switzerland.Results Concerning knowledge about statins in older adults, physicians reported defining if a patient is treated for primary or secondary prevention as challenging and that lack of evidence makes the decision to continue or discontinue the statin difficult. In terms of beliefs, fear of a possible rebound effect after statin discontinuation was reported. Regarding decision-making, physicians mentioned that statin discontinuation or continuation should be a shared decision between the patient and the physician. Concerning the professional role, environmental context and resources, the PCP office was identified as the ideal setting to discuss discontinuation, as all necessary information is available and PCPs have a longer relationship with the patients, thus facilitating a shared decision. Discontinuation of a chronic medication was perceived as difficult in general. Furthermore, PCPs noticed a possible negative impact on patient–physician relationship as some patients felt not being worth it, given up or undertreated if the statin was discontinued.Conclusions This study highlights the challenges of statin continuation and discontinuation in older patients and the crucial role of PCPs in situations with unclear evidence for a medication, where shared decision-making between physicians and patients is important. More evidence forming the background for a decision aid would be helpful.https://bmjopen.bmj.com/content/14/10/e085569.full |
| spellingShingle | Claudio Schneider Nicolas Rodondi Carole Elodie Aubert Laureline Brunner Andreas Marti Samuel Zbinden Physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention: a qualitative methods study BMJ Open |
| title | Physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention: a qualitative methods study |
| title_full | Physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention: a qualitative methods study |
| title_fullStr | Physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention: a qualitative methods study |
| title_full_unstemmed | Physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention: a qualitative methods study |
| title_short | Physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention: a qualitative methods study |
| title_sort | physician perspectives on statin continuation and discontinuation in older adults in primary cardiovascular prevention a qualitative methods study |
| url | https://bmjopen.bmj.com/content/14/10/e085569.full |
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