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Follow-up lipid tests and physician visits are associated with improved adherence to statin therapy

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Abstract

Introduction and Objective: The National Cholesterol Education Program recommends regular physician follow-up and lipid testing to promote adherence with lipidlowering medications. The objective of this study was to determine whether lipid tests and physician visits after treatment initiation are indeed associated with adherence to statin therapy.

Subjects and Methods: A retrospective cohort study was conducted among 19 422 enrolees in a US managed care plan who initiated treatment with a statin between October 1999 and August 2001. Computerised pharmacy, medical and laboratory records were used to study the patterns and predictors of adherence with lipid-lowering therapy for up to 3 years. Adherence was assessed in 3-month intervals with patients considered ‘adherent’ if ≥80% of days were covered by lipid-lowering therapy.

Results: In the first 3 months, 40% of patients had follow-up lipid tests and only 21% had dyslipidaemia visits (14% had both). Those receiving such care were substantially more likely to be adherent in subsequent intervals. Compared with those without follow-up, the relative odds of adherence were 1.42 and 1.27 for patients with one or more lipid test and one or more dyslipidaemia visit, respectively (95% confidence intervals [CI] 1.33, 1.50 and 1.16, 1.39). Patients who received a followup visit and lipid test were 45% more likely to be adherent (95% CI 1.34, 1.55). Similar associations were observed when lipid tests and dyslipidaemia visits occurred later in therapy.

Conclusion: Early and frequent follow-up by physicians — especially lipid testing — was associated with improved adherence to lipid-lowering therapy. A randomised prospective study is needed to determine whether this relationship is causal.

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Acknowledgements

Author contributions: Study concept and design: Benner, Tierce, Erbey, Sugano. Acquisition of data: Bullano, Willey. Analysis and interpretation of data: Benner, Prasad, Ballantyne, Bullano, Willey, Erbey, Sugano. Drafting of manuscript: Benner. Revision of manuscript for intellectual content: Benner, Tierce, Ballantyne, Erbey, Sugano. Statistical expertise: Benner, Bullano. Obtained funding: Erbey, Sugano. Study supervision: Tierce, Willey, Sugano

Funding/support: This research was supported by Merck/Schering-Plough.

Financial disclosure: Dr Benner, Mr Tierce and Ms Prasad are employed by ValueMedics Research, LLC, which has received payment for research and consulting services from AstraZeneca, Pfizer and Schering-Plough. Dr Ballantyne has received research grants, payment for consulting services or speakers’ honoraria from AstraZeneca, Merck, Pfizer, Novartis, Reliant, GlaxoSmithKline, diaDexus, Schering-Plough, Kos, Bristol Myers-Squibb and Sanofi-Synthelabo. Drs Bullano and Willey are employed by Health Core, Inc., which has received payment for research services from AstraZeneca, Merck and Pfizer. Drs Erbey and Sugano are employed by Schering-Plough Corporation.

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Authors and Affiliations

  1. ValueMedics Research, LLC, 11512 Waples Mill Rd, Oakton, Arlington, Virginia, 22124, USA

    Joshua S. Benner, Jonothan C. Tierce & Cheryl Prasad

  2. Baylor College of Medicine, Houston, Texas, USA

    Christie M. Ballantyne

  3. Health Core, Inc., Newark, Delaware, USA

    Michael F. Bullano & Vincent J. Willey

  4. Schering-Plough Pharmaceuticals, Kenilworth, New Jersey, USA

    John Erbey & David S. Sugano

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  1. Joshua S. Benner
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  2. Jonothan C. Tierce
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  5. Michael F. Bullano
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  8. David S. Sugano
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Correspondence to Joshua S. Benner.

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Benner, J.S., Tierce, J.C., Ballantyne, C.M. et al. Follow-up lipid tests and physician visits are associated with improved adherence to statin therapy. Pharmacoeconomic 22 (Suppl 3), 13–23 (2004). https://doi.org/10.2165/00019053-200422003-00003

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