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Adoption of new medicines in primary care: a comparison between the uptake of new oral anticoagulants and diabetes medicines.

Dankers, M., Hek, K., Mantel-Teeuwisse, A.K., Dijk, L. van, Nelissen-Vrancken, H.J.M.G. Adoption of new medicines in primary care: a comparison between the uptake of new oral anticoagulants and diabetes medicines. British Journal of Clinical Pharmacology: 2023
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Aim
To gain insight in the uptake and practice variation in the prescription of two new medicine groups for common conditions in primary care (direct-acting oral anticoagulants (DOACs) and incretin-based therapies) from introduction, around 2007, to 2019 and the correlation between the adoption of those medicines in primary care.

Methods
Prescription data from general practices in the Dutch Nivel Primary Care Database from 2007-2019 were used. The percentage of patients with prescriptions for DOACs of all patients with prescriptions for DOACs and vitamin K antagonists (VKAs) was calculated per practice per year, as was the percentage of patients prescribed incretin-based therapies as a proportion of all patients with diabetes medication. Multilevel models were used to estimate practice variation for DOACs and incretin-based therapies, expressed as intraclass correlation coefficients (ICC). Linear regression analysis was used to study the association between the prescription of DOACs and incretin-based therapies.

Results
Per year 46 to 424 general practices and 179,933 to 1,654,376 patients were included. In 2019, the mean percentage of patients per practice using DOACs or incretin-based therapies was 54.9% and 9.7%, respectively. The ICC decreased from 0.75 to 0.024 for DOACs and from 0.33 to 0.074 for incretin-based medicines during the study period. No clear correlation was found between the prescription of DOACs and incretin-based therapies.

Conclusion
DOACs and incretin based therapies have different adoption profiles and practice variation is large, especially in the years before these medicines were introduced in guidelines. Early adopters of both medicine classes differ.