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

Hjerpe, Per LU ; Ohlsson, Henrik LU ; Lindblad, Ulf; Bostrom, Kristina Bengtsson and Merlo, Juan LU (2011) In European Journal of Clinical Pharmacology 67(4). p.415-423
Abstract
In Skaraborg, Sweden, the economic responsibility for tax-financed prescription drug costs was transferred from the regional administrative level to the local level (health care centre; HCC) in 2003. The aim of this study was to investigate the impact of this decentralization of economic responsibility on adherence to guidelines for prescribing lipid-lowering drugs. Data from all 24 public HCCs in Skaraborg on prescriptions for lipid-lowering drugs during 2003 and 2005 were extracted from the Skaraborg Primary Care Database (SPCD). Multilevel regression analysis (MLRA) was used to disentangle the variances at different levels of data (patient, physician, HCC). The outcome variable on the patient level was the prescription of the... (More)
In Skaraborg, Sweden, the economic responsibility for tax-financed prescription drug costs was transferred from the regional administrative level to the local level (health care centre; HCC) in 2003. The aim of this study was to investigate the impact of this decentralization of economic responsibility on adherence to guidelines for prescribing lipid-lowering drugs. Data from all 24 public HCCs in Skaraborg on prescriptions for lipid-lowering drugs during 2003 and 2005 were extracted from the Skaraborg Primary Care Database (SPCD). Multilevel regression analysis (MLRA) was used to disentangle the variances at different levels of data (patient, physician, HCC). The outcome variable on the patient level was the prescription of the recommended statin (yes/no). Sex and age of the patients and sex, age and occupational status of the physician were included as fixed effects. The variance was expressed as the median odds ratio (MOR). The prevalence of adherence to guidelines for the prescription of statins increased from 77% in 2003 to 84% in 2005. The MLRA showed that in 2003 the variance was equally distributed between the HCC and physician levels (MORHCC2003 = 1.89 vs. MORPHYSICIAN2003 = 1.88). The variance between physicians and between HCCs decreased considerably between 2003 and 2005. The inclusion of individual and physician characteristics did not explain any of the remaining variance. The decentralized budget appears to have increased adherence to guidelines and reduced inefficient variation in prescribing. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Primary health care, Medical records systems (computerized), Drug, prescriptions, Multilevel analysis, Quality assurance, health care
in
European Journal of Clinical Pharmacology
volume
67
issue
4
pages
415 - 423
publisher
Springer
external identifiers
  • wos:000288399800011
  • scopus:79954592846
ISSN
1432-1041
DOI
10.1007/s00228-010-0973-4
language
English
LU publication?
yes
id
0d2d6119-24d4-49d6-b65e-ce77c806e7d5 (old id 1936290)
date added to LUP
2011-05-02 07:53:30
date last changed
2017-02-19 03:45:31
@article{0d2d6119-24d4-49d6-b65e-ce77c806e7d5,
  abstract     = {In Skaraborg, Sweden, the economic responsibility for tax-financed prescription drug costs was transferred from the regional administrative level to the local level (health care centre; HCC) in 2003. The aim of this study was to investigate the impact of this decentralization of economic responsibility on adherence to guidelines for prescribing lipid-lowering drugs. Data from all 24 public HCCs in Skaraborg on prescriptions for lipid-lowering drugs during 2003 and 2005 were extracted from the Skaraborg Primary Care Database (SPCD). Multilevel regression analysis (MLRA) was used to disentangle the variances at different levels of data (patient, physician, HCC). The outcome variable on the patient level was the prescription of the recommended statin (yes/no). Sex and age of the patients and sex, age and occupational status of the physician were included as fixed effects. The variance was expressed as the median odds ratio (MOR). The prevalence of adherence to guidelines for the prescription of statins increased from 77% in 2003 to 84% in 2005. The MLRA showed that in 2003 the variance was equally distributed between the HCC and physician levels (MORHCC2003 = 1.89 vs. MORPHYSICIAN2003 = 1.88). The variance between physicians and between HCCs decreased considerably between 2003 and 2005. The inclusion of individual and physician characteristics did not explain any of the remaining variance. The decentralized budget appears to have increased adherence to guidelines and reduced inefficient variation in prescribing.},
  author       = {Hjerpe, Per and Ohlsson, Henrik and Lindblad, Ulf and Bostrom, Kristina Bengtsson and Merlo, Juan},
  issn         = {1432-1041},
  keyword      = {Primary health care,Medical records systems (computerized),Drug,prescriptions,Multilevel analysis,Quality assurance,health care},
  language     = {eng},
  number       = {4},
  pages        = {415--423},
  publisher    = {Springer},
  series       = {European Journal of Clinical Pharmacology},
  title        = {Understanding adherence to therapeutic guidelines: a multilevel analysis of statin prescription in the Skaraborg Primary Care Database},
  url          = {http://dx.doi.org/10.1007/s00228-010-0973-4},
  volume       = {67},
  year         = {2011},
}