Factors predicting the prescription of cardiovascular drugs for primary prevention in patients with type 2 diabetes mellitus

Qadi, Olla ORCID: 0000-0002-4925-834X (2022). Factors predicting the prescription of cardiovascular drugs for primary prevention in patients with type 2 diabetes mellitus. University of Birmingham. Ph.D.

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Abstract

Cardiovascular complications are common in people with type 2 diabetes. In the United Kingdom, cardiovascular disease accounts for approximately 32.1% of mortality in people with type 2 diabetes. One way to tackle this is through providing eligible type 2 diabetes patients with therapeutic interventions such as lipid lowering or antihypertensive drugs to reduce the risk of cardiovascular events. Previous research reported suboptimal prescribing of such drugs in eligible patients. This thesis explored initiation of lipid lowering and antihypertensive drugs for primary prevention. Firstly, a qualitative systematic review was conducted, using thematic analysis to understand both healthcare professionals’ and patients’ attitudes and perspectives towards drugs for primary prevention of cardiovascular disease. Themes relating to patients’ attitudes towards preventive drugs included questioning preventive drugs, perceived benefits and risks, patient preferences, trust in health professionals' judgement and family, friends and media influences. Themes relating to health professional attitudes included addressing patient concerns and information, duty as a health professional to prescribe, uncertainty about preventive drug prescribing, recognising consequences of prescribing and personalised treatment. Secondly, factors predictive of drug initiation were investigated in a cohort study using a national longitudinal database of United Kingdom primary care records, the IQVIA Medical Research Database (IMRD). The study revealed a number of factors that influenced drug initiation including age, deprivation score and ethnicity. Lastly, statistically significant predictors from the retrospective cohort analysis were investigated in an experimental study using clinical vignette-based survey to elucidate which factors influence healthcare professionals to initiate preventive treatment. The survey responses revealed improvements in healthcare professionals prescribing of statins and antihypertensives in vignettes where initiation was recommended by guidelines.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):