Table 2.
General suggestions by general practitioners (GPs) and patients to increase initiation of statins
| Providers | Treatment of specific subpopulations | Patients with chronic kidney disease: |
| “I struggle with the GFRs [glomerular filtration rate] – knowing when it would be safe, when it wouldn’t be safe. I do get confused as to the dosing based on GFR.” (GP-05) | ||
| Patients who previously experienced side effects with statin(s): | ||
| “I have one strategy but if somebody is still like ‘no, it’s completely not tolerable for me’ then I don’t know what the next step is after that.” (GP-13) | ||
| Elderly patients: | ||
| “…getting some better understanding about the elderly. Are there any contraindications to starting on statin therapy? Is there one statin that may be more beneficial than another?” (GP-10) | ||
| Patients with hypertriglyceridaemia: | ||
| “I always find it hard to know what to do with triglycerides… more education around how to manage those [patients].” (GP-15) | ||
| Treatment to targets* | “Most people in my office are confused about what we are doing in terms of treating to the target of 2 mmol/L, because the cardiologist is still sending consults about that, but then we have these family medicine evidence-based groups saying that targets don’t matter”. (GP-02) | |
| “I know the TOP [Towards Optimized Practice] guidelines don’t necessarily correlate with CCS [Canadian Cardiovascular Society] guidelines, so there are several schools of thought”. (GP-09) | ||
| “There’s no real way to unify the guidelines, but to have an education session on why they’re different and how to approach it so maybe you’ll break down patient populations that fit better with one guideline vs another”. (GP-08) | ||
| Preferred modality of education | “we have a lot of drug reps [representatives] coming to town, so it would be great to have more [education] that was not pharma, absolutely”. (GP-04) | |
| EMR-based tools | “One thing that would be helpful for me is if there was some automatic flag that came when I saw a patient that would alert to the fact that their treatment is not optimized for their conditions”. (GP-06) | |
| Patients | Laboratory results | “I would like to get a copy, in addition to the doctor. I can do with it what I want” (Pt-09) |
| “It gets you questioning things so that you can come back to your doctor and say ‘I saw these numbers, what does that mean? What do I need to do?’”(Pt-02) | ||
| Enhanced education | “What if somebody was going regularly to a lab, and a clinician sort of goes: ‘How are you doing on this?’”. (Pt-08) |
*Specialist guidelines, the 2016 Canadian Cardiovascular Society guideline52 advocates that patients at high risk (based on risk calculators) or those with ‘statin-indicated conditions’ (defined as diabetes, chronic kidney disease or pre-existing vascular disease be treated with statin therapy to achieve a target LDL-c level of < 2.0 mmol/L. GP guidelines, the 2015 TOP Alberta Guideline61 encourages GPs to treat high-risk patients with moderate-to-high intensity statins and should not repeat lipid levels, or attempt to treat to a fixed target.
EMR, electronic medical record; LDL, low density lipoprotein.