I would dump this completely on the doctors responsibility.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=174254&CultureCode=en
Some stroke survivors say they are disregarding general
practitioners’ (GP) advice on secondary prevention medications, such as
statins, with some patients stopping their medication completely,
according to a study of an online stroke forum led by Queen Mary
University of London (QMUL).
The researchers say that GPs should make patients aware of multiple
treatment options and the potential need for several changes in
medication, and actively follow-up with their patients when providing
advice or changing treatment due to side effects, such as aches and
tiredness.
Three in 10 stroke survivors will go on to have a further stroke,
which causes greater disability or even death. Secondary prevention
medications, including antihypertensives, blood thinning and lipid
lowering agents, such as statins, can reduce risk of stroke recurrence
by up to 75 per cent. However, patients’ persistence with these
medications decreases over time because a minority of people experience
side effects, which are mild in most cases.
The analysis, involving University of Cambridge and published in the
journal Family Practice, was performed on the archives from TalkStroke, a
UK online forum hosted by the Stroke Association. The forum is used by
patients with stroke and their carers, and generated 21,596 posts during
2004-2011. 50 participants were found to discuss GP advice on
prevention medications in 43 discussion threads.
The side effects of secondary prevention medications, and statins in
particular, were found to cause anxiety and resentment in some patients,
and their concerns were not always addressed by GPs. While most advice
was followed, GP advice was sometimes disregarded when related to
dealing with statin side effects. Some patients even stopped the
medication after just one or two attempts by the GP to adjust statin
treatment.
Lead Researcher and NIHR Academic Clinical Lecturer Dr Anna De Simoni
from QMUL said: “I am a GP and these findings have changed my own
practice when I start patients on statins and when they consult about
side effects.
“Given the variety of cholesterol lowering treatments and possible
approaches to manage statin intolerant patients, I was surprised to see
that patients seemingly lost hope after only one or two contacts with
their GPs, unaware that a better regimen may have been available or that
their GP would have been able to carry out another change in
medication.
“In my practice I am now advising patients that multiple treatment
options are available, and several attempts may be required before a
suitable treatment is found. It is also important to pro-actively invite
them to seek help if side effects are experienced and don’t improve.”
The researchers say that advising patients to persist with statins
side effects to prevent further strokes could result in the patient
stopping the medication. Following up patients (even by telephone) after
any change in treatment or advice could ensure issues are resolved.
The study found that forum participants did not make incorrect or
misleading statements, but instead provided appropriate peer support,
underlined the central role of GPs in managing medications, and their
shared-decision making with clinicians was improved by online
peer-to-peer discussions. The forum’s ‘super-users’, who had a high
number of connections with other participants, played an important role
in this.
Considering the ease, low-cost and advantages of obtaining patient
information from online fora, the researchers say that more attention
could be paid into studying health issues using data from online
communities. This could allow collection of data from participants who
might not take part in traditional research studies and from a wider
geographical location.
The study is limited in that the data are old (2004-2011), the
identity of users could not be verified, the forum was moderated, and
older patients might be under-represented.
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