What are primary care patients’ views of CVD risk management with medicines?

Problem

Considering cardiovascular disease (CVD) in the UK, prevention of disease is a favored strategy. It saves lives, suffering and NHS resources. In parallel to the emphasis from policy-makers on primary prevention, data has been made available that supports the lowering of biomarkers with medicines in people with only a small increased risk for CVD. However, the widening of diagnostic criteria has also been criticized for potentially contributing to overprescribing.Whilst a growing biomedical evidence base guides prescribing, people’s personal understanding of health and illness also influence if and how medicines are used. Given that successful CVD risk management requires long-term engagement by large numbers of people, it is important to know how current policy and practice is perceived by those it concerns. Therefore, we set out to explore how primary care patients conceptualise CVD risk management with medicines.

Approach

Recognising that such knowledge would be related to people’s experiences and expertise as daily users of medicines, we interviewed patients diagnosed as having an elevated risk for CVD. The conceptual framework guiding our study included a synthesis of reported influences on patients’ understanding of their medicines and a suggested framework for examination of how factors in the social world contribute to medicines use. Our thematic analysis of the interviews entailed moving from descriptive coding of individual stories towards the development of an account that showed patients’ reasoning and actions related to diagnosis and medication.

Findings

Events related to CVD risk management – having a risk factor diagnosed, starting treatment, and continuing to use medicines – appear to be understood by patients through a lens of personal involvement. Both primary and secondary prevention patients interpret the diagnosed risk as a distinct medical condition with particular, and severe, consequences for themselves. Although informed by the biomedical rationale behind CVD risk management, patients’ acceptance of interventions rests on the basis of trusting their GP to provide personalised advice. This leads to a feeling of responsibility to act upon the risk by taking medicines, and also to anticipation of defined effects from them. Reaching target levels for biomarkers provides security, as it shows that the diagnosed problem is contained.

Consequences

From this investigation of patients’ views of CVD risk management, we conclude that preventive treatment suggested by a GP is interpreted by patients as a necessary intervention. When it comes to patients’ decisions about medicines, GPs seem to have a particular role as mediators between medical science and people's personal life situations. Our findings have implications for those prescribing, communicating and shaping policy aiming to manage CVD risk in the UK.