Patient Engagement is essential in improving overall population health outcomes and is an integral part of of The Triple Aim approach to optimizing the U.S. healthcare system — enhancing patient experience, improving population health, and reducing costs. “Over the past decade, research has demonstrated that engaged patients tend to have better health outcomes with lower overall costs.” ⁶ Health Affairs defines patient engagement as intervention designed to actively involve patients in their well-being and health. ⁷ There are numerous benefits of engaged patients in overall population health outcomes. “Patient engagement strategies improve patient satisfaction and adherence to treatment plans while reducing hospital utilization and costs.” ⁶ Patient engagement has been shown to improve adherence to treatment plans, increase patient satisfaction, and lower hospital utilization and healthcare costs among patients with atherosclerotic cardiovascular disease (ASCVD).

Patient non-adherence to lipid-lowering therapy is a significant issue for the prevention and treatment of ASCVD. ¹ Despite the well-documented benefits of statins, discontinuation of statin use is common among primary and secondary prevention patients. ² While it is possible that patients discontinue therapy because of poor drug effectiveness or the development of adverse effects, the West of Scotland Coronary Prevention Study found that adverse effects accounted for only 2% of the discontinuations and that the overall discontinuation rate was 30% at five years. ³

In 2011, the National Lipid Association (NLA) decided to examine the root causes of patient adherence and non-adherence to statin therapy; they collaborated with Kantar Health and Kowa Pharmaceuticals to conduct the USAGE survey to assess the attitudes, beliefs, practices and behaviors of current and former statin users. ⁴ To date, the USAGE survey is the largest survey of self-reported statin users in the United States with a total of 10,138 respondents; more than two-thirds of the patients (88%) were current statin users and only 12 % were former statin users. The current statin users demonstrated excellent adherence to therapy – 70% had not missed a dose in the past month. Almost all of the current statin users (95%) were taking a statin without any concomitant medications. Half of all USAGE survey respondents indicated their physician was their primary source of information about statin therapy; not surprisingly, current statin users reported a higher level of satisfaction than former statin users with conversations they had with their physician about the importance of cholesterol in overall health. Two-thirds of the former users cited adverse events as the primary reason that they stopped using statins. Former users also cited cost as an important factor for stopping therapy; whereas, current users cited cost as the primary reason for switching statin therapy. ⁴

Preliminary analysis of the USAGE survey provided important insights into the behaviors and attitudes among current and former statin users, and the results suggest that improving patient-provider communication may have a positive effect on adherence to statin use, especially if the patient has concerns about drug costs or side effects. ⁴

More recently, in an effort to identify those at risk for stopping statin treatment, the NLA conducted the Statin Adverse Treatment Experience survey. ⁵ The objective of this survey was to describe and assess patients’ experiences with statin associated side effects and the resulting impacts on daily life. The survey found that the top reasons patients stay on statin therapy is to avoid a heart attack, lower their cholesterol, and because of their doctor’s recommendation. The survey found that the top reasons patients stop statin therapy is because they are bothered by the side effects, cannot tolerate the side effects or the side effects interfere too much with daily life. Respondents who discontinued statins reported significantly higher mean symptom severity and impact severity scores compared with those who continued. Finally, the survey found that most patients who are not at treatment goal are willing to try other options. For example, 65% of people surveyed were willing to try a different statin and 67% of respondents who were on a statin were willing to switch to a non-statin prescription to help control cholesterol. This data supports the importance of provider engagement, risk-benefit discussions, and shared decision making when discussing the use of statin therapy.

Patient satisfaction can be improved by effective patient engagement strategies and a positive physician-patient interaction. “Adherence to treatment, provision of continuous care, clinical management of the illness and patients’ adjustment are influenced by satisfaction with physician-patient interaction.” ¹⁰ Mutual collaboration between the patient and physician can also lead to enhanced patient satisfaction. “Mutual collaboration fosters greater patient satisfaction, reduces the risks of non-adherence, and improves patients’ healthcare outcomes.” ⁹ According to Guldvog et al, satisfied patients are more likely to adhere to treatment, so it is important to evaluate to what extent patients are satisfied with health services. ¹¹ “A review of 37 randomized controlled trials found that providing patients with targeted education materials led to greater satisfaction with care.” ⁶ To improve patient satisfaction it is vital for providers to show a genuine interest in the patient, provide clear effective education, and give each patient opportunity to ask questions. ¹²

Effective communication among patients and their provider can increase patient engagement. “Previous literature suggests that an optimal patient-provider communication (PPC) is associated with more adherence to medication, lower healthcare expenditure, and higher consumer satisfaction.” ¹³ “Pivotal studies in recent years have also highlighted an association between PPC and medication refill adherence and the effect of PPC and shared decision making on blood pressure control among diabetic patients.” ^{16 , 17}

Atherosclerotic Cardiovascular Disease (ASCVD) is one of the leading causes of mortality and morbidity and a leading contributor to healthcare expenditure in the United States. ^{14 , 15} The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey was used to determine the relationship of consumer-reported patient-provider communication (PPC) among US adults with established Atherosclerotic Cardiovascular Disease. ¹³ Survey results indicated that higher rates of emergency room visits and hospitalizations were associated with poor patient-provider communication. ¹³ “ASCVD patients had a 46% higher chance of visiting the emergency room at least twice in the study year and a 42% higher likelihood of being hospitalized ≥2× if they reported a poor PPC relative to those with optimal communication with their providers.” ¹³ Poor patient-provider communication results in higher annual healthcare expenditures. ¹³ “ASCVD participants reporting poor PPC tend to spend more on health care annually. Accounting for confounding variables, those with poor PPC spent an average of $1243 more on health care annually.” ¹³

The CAHPS survey provided important insights into the behaviors and attitudes among adults with established Atherosclerotic Cardiovascular Disease, and the results suggest that “an effective interaction between patients and their healthcare providers is associated with better health outcomes and the use of more cost-effective health interventions.” ¹³