Evidence map›Paper›PMID 33569804›Full record

ArticleHealth services research2021

Physician variation in the de-adoption of ineffective statin and fibrate therapy.

Alexander Everhart, Nihar R Desai, Bryan Dowd, Jeph Herrin, Lucas Higuera, Molly Moore Jeffery, Anupam B Jena, Joseph S Ross, Nilay D Shah, Laura Barrie Smith and 1 more

Open access · greenAbstract read
In one paragraph

Article in Health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
2.0field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 7 citations in OpenAlex.

  1. Article
  2. Longitudinal Patterns in Testosterone Prescribing After US FDA Safety Communication in 2014.Joint Commission journal on quality and patient safety · 2023
    Article
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 5 institutions in 1 country.

Alexander EverhartUniversity of Minnesota, Minneapolis, Minnesota, USA.ORCID 0000-0001-5192-6557
Nihar R DesaiYale School of Medicine, Charlottesville, Virginia, USA.
Bryan DowdUniversity of Minnesota, Minneapolis, Minnesota, USA.ORCID 0000-0002-3384-5144
Jeph HerrinYale School of Medicine, Charlottesville, Virginia, USA.ORCID 0000-0002-3671-3622
Lucas HigueraUniversity of Minnesota, Minneapolis, Minnesota, USA.
Molly Moore JefferyMayo Clinic, Rochester, Minnesota, USA.ORCID 0000-0003-3854-6810
Anupam B JenaHarvard Medical School, Boston, Massachusetts, USA.ORCID 0000-0002-9734-5122
Joseph S RossYale School of Medicine, Charlottesville, Virginia, USA.
Nilay D ShahMayo Clinic, Rochester, Minnesota, USA.
Laura Barrie SmithUrban Institute, Washington, District of Columbia, USA.
Pinar Karaca-MandicUniversity of Minnesota, Minneapolis, Minnesota, USA.ORCID 0000-0002-6682-1982
University of Minnesota · USUniversity of Virginia · USMayo Clinic · USNational Bureau of Economic Research · USUrban Institute · US

Funding

Yale Clinical and Translational Science Award (U Component)UL1TR001863 · NCATS · YALE UNIVERSITY · PI John H. Krystal, LUCILA OHNO-MACHADO · 2016 to 2026
$102.9M
Understanding and Improving Healthcare Decision-Making and Outcomes for People Living with Alzheimer's Disease and Related DementiasP01AG005842 · NIA · NATIONAL BUREAU OF ECONOMIC RESEARCH · PI KOSALI ILAYPERUMA SIMON · 1986 to 2026
$56.5M
University of Minnesota AHRQ NRSA Doctoral Training ProgramT32HS000036 · AHRQ · UNIVERSITY OF MINNESOTA TWIN CITIES · PI DOWD, BRYAN EDWIN · 1989 to 2018
$5.4M
Medical reversals: De-implementing ineffective and unsafe treatmentsR01HS025164 · AHRQ · UNIVERSITY OF MINNESOTA · PI KARACA-MANDIC, PINAR · 2017 to 2020
$1.4M
Diffusion of Clinical Evidence into Practice: Physician Networks, Delivery Organizations, and MarketsR56HL130496 · NHLBI · UNIVERSITY OF MINNESOTA · PI KARACA-MANDIC, PINAR · 2016 to 2016
$634k
AHRQ HHS R01 HS025164AHRQ HHS T32 HS000036NCATS NIH HHS UL1 TR001863NHLBI NIH HHS R56 HL130496NIA NIH HHS P01 AG005842
6 · The paper itself

Abstract

objectiveTo describe physicians' variation in de-adopting concurrent statin and fibrate therapy for type 2 diabetic patients following a reversal in clinical evidence. DATA SOURCES: We analyzed 2007-2015 claims data from OptumLabs STUDY

designWe modeled fibrate use among Medicare Advantage and commercially insured type 2 diabetic statin users before and after the publication of the ACCORD lipid trial, which found statins and fibrates were no more effective than statins alone in reducing cardiovascular events among type 2 diabetic patients. We modeled fibrate use trends with physician random effects and physician characteristics such as age and specialty. DATA EXTRACTION: We identified patient-year-quarters with one year of continuous insurance enrollment, type 2 diabetes diagnoses, and fibrate use. We designated the physician most responsible for patients' diabetes care based on evaluation and management visits and prescriptions of glucose-lowering drugs. PRINCIPAL

findingsFibrate use increased by 0.12 percentage points per quarter among commercial patients (95% CI, 0.10 to 0.14) and 0.17 percentage points per quarter among Medicare Advantage patients (95% CI, 0.13 to 0.20) before the trial and then decreased by 0.16 percentage points per quarter among commercial patients (95% CI, -0.18 to -0.15) and 0.05 percentage points per quarter among Medicare Advantage patients (95% CI, -0.06 to -0.03) after the trial. However, 45% of physicians treating commercial patients and 48% of physicians treating Medicare Advantage patients had positive trends in prescribing following the trial. Physicians' characteristics did not explain their variation (pseudo R

conclusionOn average, physicians decreased fibrate prescribing following the ACCORD lipid trial. However, many physicians increased prescribing following the trial. Observable physician characteristics did not explain variations in prescribing. Future research should examine whether physicians vary similarly in other de-adoption settings.

Indexed as

AgedDiabetes Mellitus, Type 2Drug Therapy, CombinationDrug UtilizationFemaleFibric AcidsGuideline AdherenceHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHypoglycemic AgentsHypolipidemic AgentsLongitudinal StudiesMaleMedicare Part CMiddle AgedPractice Guidelines as TopicFibric AcidsHydroxymethylglutaryl-CoA Reductase InhibitorsHypoglycemic AgentsHypolipidemic Agentsdiabetes mellitusfibric acidshydroxymethylglutaryl-CoA reductase inhibitorslongitudinal studiesphysiciansType 2

Identifiers

PMID33569804
PMCPMC8522575
OpenAlexW3128155528

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.