Therapeutic traditions, patient socioeconomic characteristics and physicians’ early new drug prescribing–a multilevel analysis of rosuvastatin prescription in south Sweden

Ohlsson, Henrik; Chaix, Basile; Merlo, Juan

doi:10.1007/s00228-008-0569-4

Cited by 25 publications

(69 citation statements)

References 35 publications

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“…In line with our results, other recent studies from Nordic countries [28,29] demonstrate channelling of statin initiations, especially with newer preparations, toward healthier populations. These trends are assumed to continue as evidence for beneficial effects of statin are accumulating also among populations with low cardiovascular risk.…”

Section: Discussionsupporting

confidence: 93%

Selective prescribing of simvastatin and atorvastatin by patient characteristics at treatment initiation over a 7-year period in Finland

Halava¹,

Helin‐Salmivaara²,

Junnila³

et al. 2009

Eur J Clin Pharmacol

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Purpose The aim of the study was to investigate preferential initiation with the two most frequently used statins, simvastatin and atorvastatin, by patient characteristics over time.Methods Statin initiators without a statin prescription during the 365 days preceding the initiation from 1 January 1998 through 31 December 2004 were captured from the nation-wide Prescription Register in Finland. Associations of demographic factors and morbidities with atorvastatin versus simvastatin at initiation of statin treatment were analysed by a logistic regression model adjusted for significant covariates separately for each year. Results Of all new statin users in 1998, atorvastatin was chosen for 18% and simvastatin for 39%. In 2004, the corresponding figures were 32 and 38%. Atorvastatin was more likely than simvastatin to be initiated in younger age groups than in persons older than 74 years (reference group). Initiation with atorvastatin was less likely for people with than without coronary artery disease; adjusted odds ratios ranged from 0.62 to 0.73 over the years 1998-2003. ConclusionChannelling of atorvastatin over simvastatin toward the younger and healthier population was found during the first 4 years after its launch in Finland. Channelling may lead to confounding by indication, which must be taken into account when designing pharmacoepidemiology studies on statins.

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Section: Discussionsupporting

confidence: 93%

Selective prescribing of simvastatin and atorvastatin by patient characteristics at treatment initiation over a 7-year period in Finland

Halava¹,

Helin‐Salmivaara²,

Junnila³

et al. 2009

Eur J Clin Pharmacol

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show abstract

“…Part of this variation could in fact be at the patient level since a patient can have several visits, however, as the residuals at the patient level were not normally distributed we excluded this level from the analysis. A complementary analysis using Generalized Estimation Equations and Alternating Logistic Regression [18] also showed that the clustering at the patient level was small (pair wise odds ratio of 1.15) and that the exclusion of the patient level will have only limited effect on the variance at the higher levels.…”

Section: Discussionmentioning

confidence: 99%

Validity of registration of ICD codes and prescriptions in a research database in Swedish primary care: a cross-sectional study in Skaraborg primary care database

Hjerpe

Merlo

Boström

et al. 2010

BMC Med Inform Decis Mak

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BackgroundIn recent years, several primary care databases recording information from computerized medical records have been established and used for quality assessment of medical care and research. However, to be useful for research purposes, the data generated routinely from every day practice require registration of high quality. In this study we aimed to investigate (i) the frequency and validity of ICD code and drug prescription registration in the new Skaraborg primary care database (SPCD) and (ii) to investigate the sources of variation in this registration.MethodsSPCD contains anonymous electronic medical records (ProfDoc III) automatically retrieved from all 24 public health care centres (HCC) in Skaraborg, Sweden. The frequencies of ICD code registration for the selected diagnoses diabetes mellitus, hypertension and chronic cardiovascular disease and the relevant drug prescriptions in the time period between May 2002 and October 2003 were analysed. The validity of data registration in the SPCD was assessed in a random sample of 50 medical records from each HCC (n = 1200 records) using the medical record text as gold standard. The variance of ICD code registration was studied with multi-level logistic regression analysis and expressed as median odds ratio (MOR).ResultsFor diabetes mellitus and hypertension ICD codes were registered in 80-90% of cases, while for congestive heart failure and ischemic heart disease ICD codes were registered more seldom (60-70%). Drug prescription registration was overall high (88%). A correlation between the frequency of ICD coded visits and the sensitivity of the ICD code registration was found for hypertension and congestive heart failure but not for diabetes or ischemic heart disease.The frequency of ICD code registration varied from 42 to 90% between HCCs, and the greatest variation was found at the physician level (MORPHYSICIAN = 4.2 and MORHCC = 2.3).ConclusionsSince the frequency of ICD code registration varies between different diagnoses, each diagnosis must be separately validated. Improved frequency and quality of ICD code registration might be achieved by interventions directed towards the physicians where the greatest amount of variation was found.

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“…Despite these recommendations several studies have demonstrated substantial and unexplained differences in the adherence with guidelines among physicians and among Health Care Centres (HCC) [8,9,12,13].These differences might express themselves as a clustering of similar prescription behavior among physicians at the same HCC and suggest the existence of local therapeutic traditions. Quantifying and understanding this variation is relevant for the planning of interventions aimed to improve the 4 quality of drug prescription.…”

Section: Introductionmentioning

confidence: 99%

Understanding adherence to therapeutic guidelines: a multilevel analysis of statin prescription in the Skaraborg Primary Care Database

Hjerpe

Ohlsson

Lindblad

et al. 2010

Eur J Clin Pharmacol

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Therapeutic traditions, patient socioeconomic characteristics and physicians’ early new drug prescribing–a multilevel analysis of rosuvastatin prescription in south Sweden

Cited by 25 publications

References 35 publications

Selective prescribing of simvastatin and atorvastatin by patient characteristics at treatment initiation over a 7-year period in Finland

Selective prescribing of simvastatin and atorvastatin by patient characteristics at treatment initiation over a 7-year period in Finland

Validity of registration of ICD codes and prescriptions in a research database in Swedish primary care: a cross-sectional study in Skaraborg primary care database

Understanding adherence to therapeutic guidelines: a multilevel analysis of statin prescription in the Skaraborg Primary Care Database

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