OBJECTIVE: Lipid management (screening, risk assessment and statin use and adherence) is sub-optimal in Ontario, Canada. As part of a CIHR Strategy for Patient-Oriented Research initiative, we applied principles of implementation science, the study of methods to integrate evidence-based interventions into specific settings, to understand barriers to optimal lipid management and identify appropriate implementation strategies among primary care physicians and patients. This work will inform the interventions for an innovative, cluster randomized trial aimed at promoting the uptake of evidence-based practices for dyslipidemia management.
METHODS: We conducted a formative evaluation to assess individual level barriers and facilitators to lipid management from the perspective of primary care physicians and patients from high-risk regions in Ontario. We recruited participants through social media advertising and the study team’s circle of contacts in order to conduct semi-structured interviews. We applied validated behaviour change theories (the Theoretical Domains Framework and the Capability Opportunity Motivation– Behaviour theory) to map these barriers out to appropriate implementation strategies using the Canadian Agency for Drugs Technology and Health’s (CADTH) Rx for Change database.
RESULTS: We interviewed 9 primary care physicians and 10 residents aged 50-70 years old from rural and urban regions in Ontario. Generally, primary care physicians reported needing clarity on how to manage patients at intermediate risk of cardiovascular disease, and reported challenges with encouraging patient adherence to statins. Possible physician-oriented implementation strategies identified include developing decision support aids and training tools to better identify and manage patients at intermediate risk, and community level audit and feedback tools. Patients identified challenges with accessing high quality, unbiased health information on statin harms and benefits, and on actively engaging in their primary prevention care. Possible patient-oriented implementation strategies include developing mass media campaigns and distributing educational materials to encourage patients to undergo risk assessments and adhere to lipid medication regimens.
CONCLUSIONS: We have applied implementation science to select and operationalize potential evidence-based implementation interventions to increase the uptake of lipid management practices. Next steps include conducting a process evaluation as part of the randomized clinical trial to understand which strategies are associated with the largest effect of promoting changes in lipid management behaviour.
