Healthcare professionals’ perspectives on the use of PCSK9 inhibitors in cardiovascular disease: an in-depth qualitative study

Aims. Injectable medicines such as PCSK9 inhibitors are increasingly used to manage risk factors for cardiovascular events with little information around the perceptions of healthcare professionals (HCPs) on the administrative and clinical practicalities. The aim was to identify the facilitators and barriers on the use of injectable therapies with cardiovascular benefits through interviews with HCPs. Methods and results. Qualitative interviews were conducted in the UK (London and Leeds) and Italy (Rome and Milan) in 2021. Coding was undertaken using NVivo and thematic analysis performed. A total of 38 HCPs were interviewed, 19 in each country composing of physicians (n = 18), pharmacists (n = 10), nurses (n = 9), and pharmacy technician (n = 1). Four themes emerged: (i) clinicians’ previous experiences with injectable therapies, (ii) challenges with patients’ behaviours and beliefs, (iii) clinicians’ knowledge of injectable therapies and therapeutic inertia, and (iv) organizational and governance issues. The behaviour and beliefs from HCPs focused on facilitating behaviour change as well as the poor interdisciplinary working and collaboration. Therapeutic inertia was raised where physicians either lacked awareness of injectable therapies or were unwilling to prescribe them. The importance of facilitating patient education on injection techniques was highlighted, while organizational and governance issues identified the lack of guidance to inform practice. Clear pathways are required to identify those who were eligible for injectable therapies as well as on how injectables should be prescribed. Conclusion. If medicine optimization is to be achieved, there need to be structured processes in place to identify eligible patients and the development of educational material.