• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. Sep 2003; 53(494): 684–689.
PMCID: PMC1314690

A qualitative study of barriers to the use of statins and the implementation of coronary heart disease prevention in primary care.


BACKGROUND: Statin prescribing to prevent coronary heart disease is well below recommended levels. Studies suggest that the prescribing behaviour of doctors may be the biggest factor in the wide variation in statin prescribing in general practice. Understanding doctors' perceptions offers some insight into why variation occurs. AIM: To understand general practitioners' (GPs') views about barriers to statin prescribing, statin prescribing guidelines, and the successes and barriers to coronary prevention in primary care. DESIGN OF STUDY: Qualitative analysis of semi-structured interviews. SETTING: General practices in mid and south Bedfordshire. METHOD: Interviews with 26 GPs. RESULTS: GPs spoke of a variety of barriers to initiating statin treatment specifically, and coronary heart disease prevention generally. Barriers to statin prescribing included: concerns about cost; increased workload and adherence to treatment; variation in treatment targets for lowering cholesterol; and concerns about medicalisation, lifestyle, and health behaviour. GPs found it difficult to prioritize patients for statin treatment, their statin treatment targets varied, and many found primary prevention risk assessment tools difficult to interpret. Coronary prevention was limited by practice space and organisational issues, by problems with recording and retrieval of electronic data, and by limited doctor and nurse time. GPs suggested that funded nurse time, nurse-led heart disease clinics, and better use of electronic data would improve primary care coronary prevention. CONCLUSION: There are complex barriers to statin prescribing and coronary prevention in general practice, which may explain some of the variation that exists. Further studies of patients' views of statins may provide more information. More resources, improved guidance, and better dissemination of guidance may only address some of the issues.

Full Text

The Full Text of this article is available as a PDF (80K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Toop L, Richards D. Preventing cardiovascular disease in primary care. BMJ. 2001 Aug 4;323(7307):246–247. [PMC free article] [PubMed]
  • Fairhurst K, Huby G. From trial data to practical knowledge: qualitative study of how general practitioners have accessed and used evidence about statin drugs in their management of hypercholesterolaemia. BMJ. 1998 Oct 24;317(7166):1130–1134. [PMC free article] [PubMed]
  • Campbell NC, Thain J, Deans HG, Ritchie LD, Rawles JM. Secondary prevention in coronary heart disease: baseline survey of provision in general practice. BMJ. 1998 May 9;316(7142):1430–1434. [PMC free article] [PubMed]
  • Primatesta P, Poulter NR. Lipid concentrations and the use of lipid lowering drugs: evidence from a national cross sectional survey. BMJ. 2000 Nov 25;321(7272):1322–1325. [PMC free article] [PubMed]
  • Harnick DJ, Cohen JL, Schechter CB, Fuster V, Smith DA. Effects of practice setting on quality of lipid-lowering management in patients with coronary artery disease. Am J Cardiol. 1998 Jun 15;81(12):1416–1420. [PubMed]
  • Baxter C, Jones R, Corr L. Time trend analysis and variations in prescribing lipid lowering drugs in general practice. BMJ. 1998 Oct 24;317(7166):1134–1135. [PMC free article] [PubMed]
  • Jaye Chrys, Tilyard Murray. A qualitative comparative investigation of variation in general practitioners' prescribing patterns. Br J Gen Pract. 2002 May;52(478):381–386. [PMC free article] [PubMed]
  • Langley C, Faulkner A, Watkins C, Gray S, Harvey I. Use of guidelines in primary care--practitioners' perspectives. Fam Pract. 1998 Apr;15(2):105–111. [PubMed]
  • Mays N, Pope C. Qualitative research in health care. Assessing quality in qualitative research. BMJ. 2000 Jan 1;320(7226):50–52. [PMC free article] [PubMed]
  • Armstrong D, Reyburn H, Jones R. A study of general practitioners' reasons for changing their prescribing behaviour. BMJ. 1996 Apr 13;312(7036):949–952. [PMC free article] [PubMed]
  • Bradley CP. Factors which influence the decision whether or not to prescribe: the dilemma facing general practitioners. Br J Gen Pract. 1992 Nov;42(364):454–458. [PMC free article] [PubMed]
  • Pharoah PD, Hollingworth W. Cost effectiveness of lowering cholesterol concentration with statins in patients with and without pre-existing coronary heart disease: life table method applied to health authority population. BMJ. 1996 Jun 8;312(7044):1443–1448. [PMC free article] [PubMed]
  • Teo Koon K, Burton Jeffrey R. Who should receive HMG CoA reductase inhibitors? Drugs. 2002;62(12):1707–1715. [PubMed]
  • Evans JS, Harries C, Dennis I, Dean J. General practitioners' tacit and stated policies in the prescription of lipid lowering agents. Br J Gen Pract. 1995 Jan;45(390):15–18. [PMC free article] [PubMed]
  • Gillies John, Sheehan Martin. Practical reasoning and decision making--Hippocrates' problem, Aristotle's answer. Br J Gen Pract. 2002 Jun;52(479):518–519. [PMC free article] [PubMed]
  • Thomsen TF, Jørgensen T, Ibsen H, Borch-Johnsen K. Assessment of coronary risk in general practice in relation to the use of guidelines: a survey in Denmark. Prev Med. 2001 Oct;33(4):300–304. [PubMed]
  • Rogers Wendy A. Are guidelines ethical? Some considerations for general practice. Br J Gen Pract. 2002 Aug;52(481):663–668. [PMC free article] [PubMed]
  • Murchie Peter, Campbell Neil C, Ritchie Lewis D, Simpson Julie A, Thain Joan. Secondary prevention clinics for coronary heart disease: four year follow up of a randomised controlled trial in primary care. BMJ. 2003 Jan 11;326(7380):84–84. [PMC free article] [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...