ArticleEuropean journal of clinical pharmacology2011
Understanding adherence to therapeutic guidelines: a multilevel analysis of statin prescription in the Skaraborg Primary Care Database.
Article in European journal of clinical pharmacology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
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- Geographical and sociodemographic differences in discontinuation of medication for Chronic Obstructive Pulmonary Disease - A Cross-Classified Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA).Clinical epidemiology · 2020Article
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- Geographic Disparity in Deceased Donor Liver Transplant Rates Following Share 35.Transplantation · 2019Article
- Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance.BMJ open quality · 2019Article
- The median hazard ratio: a useful measure of variance and general contextual effects in multilevel survival analysis.Statistics in medicine · 2017Article
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- Prescriber variation in potentially inappropriate prescribing in older populations in Ireland.BMC family practice · 2014Article
- Increased registration of hypertension and cancer diagnoses after the introduction of a new reimbursement system.Scandinavian journal of primary health care · 2012Article
- Practice variation in a longitudinal perspective: a multilevel analysis of the prescription of simvastatin in general practices between 2003 and 2009.European journal of clinical pharmacology · 2011Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeIn 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.
methodsData 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).
resultsThe 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 (MOR(HCC2003)=1.89 vs. MOR(PHYSICIAN2003)=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.
conclusionThe decentralized budget appears to have increased adherence to guidelines and reduced inefficient variation in prescribing.
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