06 May Polypill For Heart Disease May Improve Compliance, Reduces Costs
MedicalResearch.com Interview with:
Hueiming Liu | BA (Hons), MBBS, MIPH
Research Fellow, Renal & Metabolic Division
The George Institute for Global Health
Medical Research: What is the background for this study?
Dr. Liu: Cardiovascular disease is a major cause of mortality and morbidity worldwide and is projected to be the leading cause of death in 2030. A major part of the problem is large treatment gaps globally. Cardiovascular polypills which are fixed dose combinations of frequently indicated cardiovascular medications for high risk primary prevention and secondary prevention have been trialled internationally to improve provider prescribing and patient medication use. Encouragingly, recent results from randomised controlled trials have shown effectiveness in improving adherence. This study is part of a process evaluation of a pragmatic randomised, controlled trial evaluating a polypill-based strategy for high-risk primary and secondary cardiovascular disease prevention in Australian primary health care. The trial results showed that “ After a median of 18 months, the polypill-based strategy was associated with greater use of combination treatment (70% vs. 47%; relative risk 1.49, (95% confidence interval (CI) 1.30 to 1.72) p < 0.0001; number needed to treat = 4.4 (3.3 to 6.6)) without differences in systolic blood pressure (-1.5 mmHg (95% CI -4.0 to 1.0) p = 0.24) or total cholesterol (0.08 mmol/l (95% CI -0.06 to 0.22) p = 0.26).” Ultimately, the trial was underpowered for clinical outcomes, but in a separate meta-analysis that included 2 other trials using a near identical protocol in other countries, the polypill strategy was associated with significant reductions in blood pressure and LDL cholesterol. A within-trial cost analysis of polypill-based care versus usual care with separate medications showed a statistically significantly lower mean pharmaceutical expenditure and thus potential cost savings to tax payers and the Australian government should the polypill strategy be introduced.
In this qualitative study, we explored health provider and patient attitudes towards the use of a cardiovascular polypill as a health service strategy to improve cardiovascular prevention in Australia through in-depth, semi-structured interviews with 47 health providers and 47 patients involved in the trial.
Medical Research: What are the main findings?
Dr. Liu: We found that there was general acceptability for the strategy from both providers and patients. 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 service 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.
Medical Research: What should clinicians and patients take away from your report?
Dr. Liu: The cardiovascular polypill can be an effective and cost effective health service strategy in changing prescribing behaviour and facilitating patient medication adherence. However, medication adherence is complex and requires clinicians to consider the polypill strategy alongside other strategies and cater to specific patient contextual factors such as health literacy, sense of well-being, financial considerations, establishing ongoing respectful clinician and patient relationship and improving accessibility to health care.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Liu: The cardiovascular polypill could be trialled with other evidence based strategies in cardiovascular prevention. Research of different combinations of cardiovascular polypills could increase clinicians’ flexibility in prescribing indicated CVD medications. Our experience with this process evaluation have highlighted that future qualitative research embedded into randomised controlled trials of complex behavioural change is valuable.
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
Hueiming Liu, Luciana Massi, Tracey-Lea Laba, David Peiris, Tim Usherwood, Anushka Patel, Alan Cass, Anne-Marie Eades, Julie Redfern, Noel Hayman, Kirsten Howard, Jo-anne Brien, and Stephen Jan
Circ Cardiovasc Qual Outcomes. 2015;CIRCOUTCOMES.115.001483published online before print May 5 2015, doi:10.1161/CIRCOUTCOMES.115.001483
MedicalResearch.com Interview with: Hueiming Liu | BA (Hons), MBBS, MIPH (2015). Polypill For Heart Disease May Improve Improve Compliance, Reduces Costs MedicalResearch.com