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

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Objective

The aim was to investigate the role that municipalities and out-patient health care centres (HCCs) have in understanding adherence to official guidelines on statin prescribing. Our hypothesis was that after guideline publication, adherence to recommended statin prescription would increase and variance among HCCs and municipalities would decrease. Since multi-level regression analysis (MLRA) is a relatively new methodology in pharmacoepidemiology, we also aimed to explore the application of MLRA in our investigation.

Methods

We obtained data from the Swedish Corporation of Pharmacies record of sales regarding all initial prescriptions of statins issued between April and December 2003. We applied multi-level analysis on 34,514 individual prescriptions (level 1) nested within 226 HCCs (level 2), which in turn were nested within 33 municipalities (level 3). Temporal trends and gender differences were investigated by means of random slope analysis. Variance was expressed using median odds ratio (MOR) and interval odds ratio.

Results

HCCs appeared to be more relevant than municipalities for understanding the physicians’ propensity to prescribe a recommended statin (MORHCC=1.96 and MORMunicipality=1.41). Overall prevalence of adherence was very low (about 20%). After publication of the guidelines, prescription of recommended statins increased, and variance among HCCs decreased but only during the first 4 months of the observation period.

Conclusion

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.

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Acknowledgements

This study was supported by grants from the Scania Region’s Health Care Research Funds, the Swedish Council for Working Life and Social Research (FAS) (Juan Merlo; Dnr 2003-0580), and the Swedish Research Council (VR) (Juan Merlo; Dnr 2004-6155).

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Authors and Affiliations

  1. Drug Utilization Unit, Scania Region, Regionhuset, Box 1, 22100, Lund, Sweden

    H. Ohlsson, T. Lithman & B. Ericsson

  2. Community Medicine, Department of Medical Science, Malmö University Hospital, Faculty of Medicine, Lund University, 20502, Malmö, Sweden

    H. Ohlsson, U. Lindblad, U. -G. Gerdtham, L. Råstam & J. Merlo

  3. The Skaraborg Institute, Skövde, Sweden

    U. Lindblad

  4. The NEPI Foundation, Malmö University Hospital, Malmö, Sweden

    A. Melander

Authors
  1. H. Ohlsson
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  2. U. Lindblad
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  3. T. Lithman
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  4. B. Ericsson
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  5. U. -G. Gerdtham
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  6. A. Melander
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  7. L. Råstam
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  8. J. Merlo
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Corresponding authors

Correspondence to H. Ohlsson or J. Merlo.

Additional information

This study has been presented as an abstract at the 20th International Conference of Pharmacoepidemiology and Therapeutic Risk Management, Bordeaux, France, in August 2004; the 3rd Nordic Conference in Epidemiology, Kuopio, Finland, in June 2004; and the first Nordic Social Pharmacy and Health Service Research Conference, Uppsala, Sweden, in October 2004.

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Ohlsson, H., Lindblad, U., Lithman, T. et al. Understanding adherence to official guidelines on statin prescribing in primary health care—a multi-level methodological approach. Eur J Clin Pharmacol 61, 657–665 (2005). https://doi.org/10.1007/s00228-005-0975-9

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  • DOI: https://doi.org/10.1007/s00228-005-0975-9

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