Statin prescribing in patients with newly diagnosed type 2 diabetes mellitus: a multilevel analysis.

Ohlsson, H., Nielen, M., Dijk, L. van. Statin prescribing in patients with newly diagnosed type 2 diabetes mellitus: a multilevel analysis. Pharmacoepidemiology and Drug Safety: 2011, 20(suppl. 1), p. S292 - S293. Abstract. 27th International Conference on Pharmacoepidemiology and Therapeutic Risk Management, 14-17 Augustus 2011, Chicago.
Background: As of 2006 Dutch primary care guidelines recommend to prescribe a statin to almost all patients with type 2 diabetes mellitus (DM). Generally, implementation of guideline recommendations is a complex process and large variation exists between general practitioners in guideline adherence. Objectives: To describe the trend in prescribing statins to newly diagnosed DM2 patients, including time to first statin prescription after being diagnosed as well as interpractice variation. Methods: We used data from the Netherlands Information Network of General Practice (LINH), a dynamic representative pool of general practices, from the period 2003 to 2008. We selected all newly diagnosed diabetes patients (n=8,064). Treatment with statins was investigated by multilevel proportional hazards regression models with individuals nested within practices. Follow-up time in number of days was measured from the date of diagnose/prescription of diabetes, until the date of the first prescription of statins, death, signing out of practice or end of follow-up (188 days after diabetes prescription/diagnose), which ever came first. Results: The proportion of newly diagnosed diabetes patients that received a statin prescription continuously increased from 9% in 2003 to 31% in 2008. In addition, the average number of days till statin prescription decreased from 178 to 142 days after diagnosis. Interpractice variation (ICC) in prescribing statins to newly diagnosed DM2 patients was between 15 and 17% in the study period and did not change over time. Conclusions: The recommendations in the Dutch primary care guidelines promoted prescription of statins in newly diagnosed patients with diabetes but the variation between practices is still high. More intensive interventions may be necessary to promote rational statin prescription and to decrease interpractice variation. (aut. ref.)