Factors affecting statin uptake among people living with HIV: primary care provider perspectives
Abstract Background Cardiovascular disease (CVD) is a major cause of morbidity and mortality among people living with HIV (PLWH), but statin therapy, safe and effective for PLWH, is under-prescribed. This study examined clinic leadership and provider perceptions of factors associated with statin pre...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | BMC Family Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12875-021-01563-0 |
| _version_ | 1818234947911024640 |
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| author | Allison J. Ober Sae Takada Deborah Zajdman Ivy Todd Tamara Horwich Abraelle Anderson Soma Wali Joseph A. Ladapo |
| author_facet | Allison J. Ober Sae Takada Deborah Zajdman Ivy Todd Tamara Horwich Abraelle Anderson Soma Wali Joseph A. Ladapo |
| author_sort | Allison J. Ober |
| collection | DOAJ |
| description | Abstract Background Cardiovascular disease (CVD) is a major cause of morbidity and mortality among people living with HIV (PLWH), but statin therapy, safe and effective for PLWH, is under-prescribed. This study examined clinic leadership and provider perceptions of factors associated with statin prescribing for PLWH receiving care in eight community health clinics across Los Angeles, California. Methods We conducted semi-structured telephone interviews with clinic leadership and providers across community health clinics participating in a larger study (INSPIRE) aimed at improving statin prescribing through education and feedback. Clinics included federally qualified health centers (N = 5), community clinics (N = 1) and county-run ambulatory care clinics (N = 2). Leadership and providers enrolled in INSPIRE (N = 39) were invited to participate in an interview. We used the Consolidated Framework for Implementation Research (CFIR) to structure our interview guide and analysis. We used standard qualitative content analysis methods to identify themes within CFIR categories; we also assessed current CVD risk assessment and statin-prescribing practices. Results Participants were clinic leaders (n = 6), primary care physicians with and without an HIV specialization (N = 6, N = 6, respectively), infectious diseases specialists (N = 12), nurse practitioners, physician assistants and registered nurses (N = 7). Ninety-five percent of providers from INSPIRE participated in an interview. We found that CVD risk assessment for PLWH is standard practice but that there is variation in risk assessment practices and that providers are unsure whether or how to adjust the risk threshold to account for HIV. Time, clinic and patient priorities impede ability to conduct CVD risk assessment with PLWH. Conclusions Providers desire more data and standard practice guidance on prescribing statins for PLWH, including estimates of the effect of HIV on CVD, how to adjust the CVD risk threshold to account for HIV, which statins are best for people on antiretroviral therapy and on shared decision-making around prescribing statins to PLWH. While CVD risk assessment and statin prescribing fits within the mission and workflow of primary care, clinics may need to emphasize CVD risk assessment and statins as priorities in order to improve uptake. |
| first_indexed | 2024-12-12T11:46:10Z |
| format | Article |
| id | doaj.art-1329f5e935ae4cd2a45c18f1c575e03a |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-12-12T11:46:10Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-1329f5e935ae4cd2a45c18f1c575e03a2022-12-22T00:25:26ZengBMCBMC Family Practice1471-22962021-10-0122111310.1186/s12875-021-01563-0Factors affecting statin uptake among people living with HIV: primary care provider perspectivesAllison J. Ober0Sae Takada1Deborah Zajdman2Ivy Todd3Tamara Horwich4Abraelle Anderson5Soma Wali6Joseph A. Ladapo7RAND CorporationRAND CorporationRAND CorporationRAND CorporationDivision of Cardiology, Department of Medicine, UCLA Geffen School of MedicineDivision of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of MedicineOlive View – UCLA Medical CenterDivision of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of MedicineAbstract Background Cardiovascular disease (CVD) is a major cause of morbidity and mortality among people living with HIV (PLWH), but statin therapy, safe and effective for PLWH, is under-prescribed. This study examined clinic leadership and provider perceptions of factors associated with statin prescribing for PLWH receiving care in eight community health clinics across Los Angeles, California. Methods We conducted semi-structured telephone interviews with clinic leadership and providers across community health clinics participating in a larger study (INSPIRE) aimed at improving statin prescribing through education and feedback. Clinics included federally qualified health centers (N = 5), community clinics (N = 1) and county-run ambulatory care clinics (N = 2). Leadership and providers enrolled in INSPIRE (N = 39) were invited to participate in an interview. We used the Consolidated Framework for Implementation Research (CFIR) to structure our interview guide and analysis. We used standard qualitative content analysis methods to identify themes within CFIR categories; we also assessed current CVD risk assessment and statin-prescribing practices. Results Participants were clinic leaders (n = 6), primary care physicians with and without an HIV specialization (N = 6, N = 6, respectively), infectious diseases specialists (N = 12), nurse practitioners, physician assistants and registered nurses (N = 7). Ninety-five percent of providers from INSPIRE participated in an interview. We found that CVD risk assessment for PLWH is standard practice but that there is variation in risk assessment practices and that providers are unsure whether or how to adjust the risk threshold to account for HIV. Time, clinic and patient priorities impede ability to conduct CVD risk assessment with PLWH. Conclusions Providers desire more data and standard practice guidance on prescribing statins for PLWH, including estimates of the effect of HIV on CVD, how to adjust the CVD risk threshold to account for HIV, which statins are best for people on antiretroviral therapy and on shared decision-making around prescribing statins to PLWH. While CVD risk assessment and statin prescribing fits within the mission and workflow of primary care, clinics may need to emphasize CVD risk assessment and statins as priorities in order to improve uptake.https://doi.org/10.1186/s12875-021-01563-0Cardiovascular diseaseASCVD risk assessmentStatin therapypeople living with HIV |
| spellingShingle | Allison J. Ober Sae Takada Deborah Zajdman Ivy Todd Tamara Horwich Abraelle Anderson Soma Wali Joseph A. Ladapo Factors affecting statin uptake among people living with HIV: primary care provider perspectives BMC Family Practice Cardiovascular disease ASCVD risk assessment Statin therapy people living with HIV |
| title | Factors affecting statin uptake among people living with HIV: primary care provider perspectives |
| title_full | Factors affecting statin uptake among people living with HIV: primary care provider perspectives |
| title_fullStr | Factors affecting statin uptake among people living with HIV: primary care provider perspectives |
| title_full_unstemmed | Factors affecting statin uptake among people living with HIV: primary care provider perspectives |
| title_short | Factors affecting statin uptake among people living with HIV: primary care provider perspectives |
| title_sort | factors affecting statin uptake among people living with hiv primary care provider perspectives |
| topic | Cardiovascular disease ASCVD risk assessment Statin therapy people living with HIV |
| url | https://doi.org/10.1186/s12875-021-01563-0 |
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