Physician variation in the de‐adoption of ineffective statin and fibrate therapy

Abstract

Objective To describe physicians’ variation in de‐adopting concurrent statin and fibrate therapy for type 2 diabetic patients following a reversal in clinical evidence. Data Sources We analyzed 2007‐2015 claims data from OptumLabs® Data Warehouse, a longitudinal, real‐world data asset with de‐identified administrative claims and electronic health record data. Study Design We modeled fibrate use among Medicare Advantage and commercially insured type 2 diabetic statin users before and after the publication of the ACCORD lipid trial, which found statins and fibrates were no more effective than statins alone in reducing cardiovascular events among type 2 diabetic patients. We modeled fibrate use trends with physician random effects and physician characteristics such as age and specialty. Data Extraction We identified patient‐year‐quarters with one year of continuous insurance enrollment, type 2 diabetes diagnoses, and fibrate use. We designated the physician most responsible for patients’ diabetes care based on evaluation and management visits and prescriptions of glucose‐lowering drugs. Principal Findings Fibrate use increased by 0.12 percentage points per quarter among commercial patients (95% CI, 0.10 to 0.14) and 0.17 percentage points per quarter among Medicare Advantage patients (95% CI, 0.13 to 0.20) before the trial and then decreased by 0.16 percentage points per quarter among commercial patients (95% CI, −0.18 to −0.15) and 0.05 percentage points per quarter among Medicare Advantage patients (95% CI, −0.06 to −0.03) after the trial. However, 45% of physicians treating commercial patients and 48% of physicians treating Medicare Advantage patients had positive trends in prescribing following the trial. Physicians’ characteristics did not explain their variation (pseudo R2 = 0.000). Conclusion On average, physicians decreased fibrate prescribing following the ACCORD lipid trial. However, many physicians increased prescribing following the trial. Observable physician characteristics did not explain variations in prescribing. Future research should examine whether physicians vary similarly in other de‐adoption settings.

Association of Fluoroquinolone Prescribing Rates With Black Box Warnings from the US Food and Drug Administration

“…The analysis focused on 3 periods: before the 2013 warning (baseline period), after the 2013 warning but before the 2016 warning (postwarning period 1), and after the 2016 warning (postwarning period 2). We also sought to ascertain whether variations in de-adoption (defined as the discontinuation of a clinical practice after it was previously adopted, especially because of ineffective and harmful practices) 15 , 16 , 17 , 18 , 19 existed across organizational affiliations and specialties, identifying areas wherein inappropriate prescribing has persisted, which can ultimately lead to improved patient safety.…”

Investigating Lipid-Modulating Agents for Prevention or Treatment of COVID-19

“…Despite the declining use for cardiovascular risk reduction ( 58 ), fibrates may decrease viral entry and SARS-CoV-2 infectivity by increasing sulfatide levels ( 59 ) and inhibiting the receptor-binding domain to ACE2 ( 33 ). Strengths of the ongoing fibrate trials include endpoint selection; death, ARDS-related outcomes, inflammatory markers, and invasive mechanical support are the primary outcomes under evaluation.…”

Lipid-Modulating Agents for Prevention or Treatment of COVID-19 in Randomized Trials

“…Despite the declining use for cardiovascular risk reduction (57), fibrates may decrease viral entry and SARS-CoV-2 infectivity by increasing sulfatide levels (58) and inhibiting the receptor binding domain to ACE2 (33). Strengths of ongoing fibrate trials include endpoint selection: death, ARDS-related outcomes, inflammatory markers and invasive mechanical support are the primary outcome under evaluation.…”