Understanding adherence to official guidelines on statin prescribing in primary health care—a multi-level methodological approach

Abstract

The publication of official guidelines in the county of Scania exerted a positive influence on statin prescription but, at the end of the observation period, adherence was still low and practice variation high. These facts may reflect inefficient therapeutic traditions and suggest that more intensive interventions may be necessary to promote rational statin prescription.

Is the physician's adherence to prescription guidelines associated with the patient's socio-economic position? An analysis of statin prescription in South Sweden

“…In previous studies, we have shown that physicians working at private practices have a much lower adherence to prescription guidelines;2 3 this might stem from poorer receptivity to the county council policies, and these circumstances might modify the effect of the other included variables. It is also known that private care attracts more high-SEP patients than does public care 22 23.…”

“…We used this percentage to estimate the relevance of the individual and contextual characteristics for understanding a possible clustering of prescriptions of recommended statins 2 3…”

“…Such practice differences in adherence to prescription guidelines might also express inefficient therapeutic traditions, especially when the brands prescribed are more expensive than the recommended ones 2 3 16…”

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

“…Moreover guidelines may also be an aid for prescribers that are hardly able to assimilate the increasing volume of new scientific information [1,[3][4][5]. Even though the investigation of adherence to guidelines is attracting increasing interest, it is still not sufficiently understood what and how factors at different levels of the health care organization condition adherence to guidelines [6][7][8][9].…”

“…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.…”