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Trends and interpractice variation in the prescription of statins between 2003 and 2008: a multilevel approach.

Ohlsson, H., Dijk, L. van. Trends and interpractice variation in the prescription of statins between 2003 and 2008: a multilevel approach. European Journal of Public Health: 2010, 20(suppl. 1), p. 128. Abstract. 3rd European Public Health Conference 'Integrated Public Health', 10 - 13 November 2010, Amsterdam.
Background: In 2006, The Netherlands College of General Practitioners introduced a new guideline on Cardiovascular Risk Management. Two major aspects in this guideline were: (i) simvastatin is first choice when prescribing a statin; (ii) patients with type 2 diabetes should be prescribed a statin. Our aim is therefore to study the trends and interpractice variation in prescription of simvastatin and to study the prescription of statins to newly diagnosed patients with type-2 diabetes between the years 2003 and 2008 Methods: We used data from The Netherlands Information Network
of General Practice (LINH) from the period 2003 to 2008. First, we selected all patients with a new prescription of statins (n = 43 911) and investigated, with multilevel logistic regression, the share of simvastatin of all statin prescriptions. Differences between practices were expressed by the intra class correlation (ICC). Secondly, we selected all newly diagnosed diabetes patients (n = 17 025) and investigated with Cox regression analysis the time to their first statin prescription. Results: The prevalence of simvastatin of all statins increased continuously over time; from 40% in 2003 to 68% in 2008. However, the variance between practices also seemed to increase (ICC2003 = 13% and ICC2008 = 18%). Compared with patients diagnosed with diabetes in 2003, patients diagnosed in the year 2006 had 3.75 times higher hazard of receiving a statin prescription within a year. On the other hand, the hazards ratio (HR) was lower in the years 2007 (HR: 3.16) and 2008 (HR: 2.90). Conclusions: The guidelines seem to promote prescription of simvastatin but the variation between practices continued to being high. Moreover, the guidelines seemed to support the prescription of statins to patients with diabetes. However, as there seemed to be a decreasing trend towards level prior to the guidelines more intensive interventions may be necessary to promote rational statin prescription. (aut.ref.)