Overprescribing of lipid lowering agents

Abstract

Background: Undertreatment of hyperlipidemia has received considerable attention. However, little is known about trends in overprescribing of lipid lowering agents. We examined these trends and their associations with physician, practice, and organisational factors. Methods: 2034 physicians were surveyed twice: baseline (1996-7) and follow up . On each occasion they were asked: ''For what percentage of 50 year old men without other cardiac risk factors would you recommend an oral agent for total cholesterol of 240, LDL 150, and HDL 50 after 6 months on a low cholesterol diet?'' During the survey period the National Cholesterol Education Program guidelines did not recommend prescribing for these patients. Binomial and multinomial logistic regressions assessed baseline overprescribing and longitudinal changes in overprescribing, accounting for complex sampling. Results: 39% of physicians recommended prescribing at baseline (round 1), increasing at follow up (round 2) to 51% (p,0.001). Physicians who were more likely to overprescribe at baseline were less likely to be board certified (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.38 to 0.63; p,0.001), were in solo or two-physician practices (OR 1.88, 95% CI 1.46 to 2.41; p,0.001), had more revenue from Medicare (OR 1.10, 95% CI 1.03 to 1.17; p = 0.004) or Medicaid (OR 1.09, 95% CI 1.01 to 1.18; p = 0.03), or were family physicians (OR 1.87, 95% CI 1.35 to 2.58; p,0.001). Physicians with large increases in overprescibing were more likely than those with small increases in overprescribing to be international medical graduates (OR 2.09, 95% CI 1.20 to 3.64; p = 0.011) and to spend more hours in patient care (OR 1.14, 95% CI 1.03 to 1.26; p = 0.016). Conclusions: Overprescribing of lipid lowering agents is commonplace and increased. At baseline and longitudinally, overprescribing was primarily associated with physician and practice characteristics and not with organisational factors.

GPs’ Perceptions of Cardiovascular Risk and Views on Patient Compliance: A Qualitative Interview Study

“…Some might fail to see the relevance of GPs taking blood samples or even statins themselves to be a measure of how they treat their patients with elevated blood lipids. It has, however, previously been shown that doctors personal health habits and beliefs about counselling [ 37 , 38 ], as well as personal characteristics [ 39 , 40 ], strongly influence their practices in counselling patients about health habits. We recognise that a GP's prescribing decision is also the result of many external inputs from the patient, commercial sources, professional colleagues, the academic literature, and government regulators [ 41 ].…”

Barriers to physician adherence to nonsteroidal anti‐inflammatory drug guidelines: a qualitative study

“…Lack of familiarity with guidelines was the most frequently cited barrier by participants. Physicians’ lack of familiarity with guidelines has been shown to influence a number of clinical outcomes including control of hypertension, promotion of exercise stress testing, colon‐cancer screening, smoking cessation and asthma compliance, 11, 16–18 resulting both in under‐ and over‐treatment of the medical condition 16, 19 . In our study, many physicians voiced concerns that their unfamiliarity with published guidelines often resulted in non‐evidence‐based prescribing patterns.…”

The influence of body mass index, age and gender on current illness: a cross-sectional study

“…Although our study was not designed to study the causes of the increased use of medication, one possibility is an increased morbidity related to the increased BMI between the two periods; another is possible changes in physician prescribing patterns, such as more aggressive treatment. [32][33][34][35] Several factors require consideration in interpreting the findings reported herein. The use of reported medications was only a proxy for actual illness load.…”