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King W, Lacey A, White J, Farewell D, Dunstan F, Fone D. Socioeconomic inequality in medication persistence in primary and secondary prevention of coronary heart disease - A population-wide electronic cohort study. PLoS One 2018. [PMID: 29522561 PMCID: PMC5844560 DOI: 10.1371/journal.pone.0194081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Coronary heart disease (CHD) mortality in England fell by 36% between 2000 and 2007 and it is estimated that approximately 50% of the fall was due to improved treatment uptake. Marked socio-economic inequalities in CHD mortality in the United Kingdom (UK) remain, with higher age-adjusted rates in more deprived groups. Inequalities in the persistence of medication for primary and secondary prevention of CHD may contribute to the observed social gradient and we investigated this possibility in the population of Wales (UK). Methods and findings An electronic cohort of individuals aged over 20 (n = 1,199,342) in Wales (UK) was formed using linked data from primary and secondary care and followed for six years (2004–2010). We identified indications for medication (statins, aspirin, ACE inhibitors, clopidogrel) recommended in UK National Institute for Clinical Excellence (NICE) guidance for CHD (high risk, stable angina, stable angina plus diabetes, unstable angina, and myocardial infarction) and measured the persistence of indicated medication (time from initiation to discontinuation) across quintiles of the Welsh Index of Multiple Deprivation, an area-based measure of socio-economic inequality, using Cox regression frailty models. In models adjusted for demographic factors, CHD risk and comorbidities across 15 comparisons for persistence of the medications, none favoured the least deprived quintile, two favoured the most deprived quintile and 13 showed no significant differences. Conclusions During our study period (2004–2010) we found no significant evidence of socio-economic inequality in the persistence of recommended medication for primary and secondary prevention of CHD.
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Affiliation(s)
- William King
- Public Health Wales, Cardiff, United Kingdom
- * E-mail:
| | - Arron Lacey
- College of Medicine, Swansea University, Swansea, United Kingdom
| | - James White
- Centre for the Development and Evaluation of Complex Public Health Interventions and South East Wales Trials Unit, Cardiff University, Cardiff, United Kingdom
| | - Daniel Farewell
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - Frank Dunstan
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
| | - David Fone
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
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King W, Lacey A, White J, Farewell D, Dunstan F, Fone D. Equity in healthcare for coronary heart disease, Wales (UK) 2004-2010: A population-based electronic cohort study. PLoS One 2017; 12:e0172618. [PMID: 28301496 PMCID: PMC5354260 DOI: 10.1371/journal.pone.0172618] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/06/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite substantial falls in coronary heart disease (CHD) mortality in the United Kingdom (UK), marked socioeconomic inequalities in CHD risk factors and CHD mortality persist. We investigated whether inequity in CHD healthcare in Wales (UK) could contribute to the observed social gradient in CHD mortality. METHODS AND FINDINGS Linking data from primary and secondary care we constructed an electronic cohort of individuals (n = 1199342) with six year follow-up, 2004-2010. We identified indications for recommended CHD interventions, measured time to their delivery, and estimated risk of receiving the interventions for each of five ordered deprivation groups using a time-to-event approach with Cox regression frailty models. Interventions in primary and secondary prevention included risk-factor measurement, smoking management, statins and antihypertensive therapy, and in established CHD included medication and revascularization. For primary prevention, five of the 11 models favoured the more deprived and one favoured the less deprived. For medication in secondary prevention and established CHD, one of the 15 models favoured the more deprived and one the less deprived. In relation to revascularization, six of the 12 models favoured the less deprived and none favoured the more deprived-this evidence of inequity exemplified by a hazard ratio for revascularization in stable angina of 0.79 (95% confidence interval 0.68, 0.92). The main study limitation is the possibility of under-ascertainment or misclassification of clinical indications and treatment from variability in coding. CONCLUSIONS Primary care components of CHD healthcare were equitably delivered. Evidence of inequity was found for revascularization procedures, although this inequity is likely to have only a modest effect on social gradients in CHD mortality. Policymakers should focus on reducing inequalities in CHD risk factors, particularly smoking, as these, rather than inequity in healthcare, are likely to be key drivers of inequalities in CHD mortality.
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Affiliation(s)
- William King
- Aneurin Bevan Gwent Local Public Health Team, Public Health Wales, Newport, Wales, United Kingdom
| | - Arron Lacey
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - James White
- Centre for the Development and Evaluation of Complex Public Health Interventions and South East Wales Trials Unit, Cardiff University, Wales, United Kingdom
| | - Daniel Farewell
- Division of Population Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Frank Dunstan
- Division of Population Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - David Fone
- Division of Population Medicine, Cardiff University, Cardiff, Wales, United Kingdom
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Asthana S, Gibson A, Bailey T, Moon G, Hewson P, Dibben C. Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BackgroundA strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.ObjectivesTo generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.DesignCross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).ResultsThe utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primary management are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.ConclusionsWe found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns of utilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sheena Asthana
- School of Government, University of Plymouth, Plymouth, UK
| | - Alex Gibson
- School of Government, University of Plymouth, Plymouth, UK
| | - Trevor Bailey
- College of Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Graham Moon
- School of Geography and the Environment, University of Southampton, Southampton, UK
| | - Paul Hewson
- School of Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh, UK
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O'Keeffe AG, Petersen I, Nazareth I. Initiation rates of statin therapy for the primary prevention of cardiovascular disease: an assessment of differences between countries of the UK and between regions within England. BMJ Open 2015; 5:e007207. [PMID: 25748418 PMCID: PMC4360592 DOI: 10.1136/bmjopen-2014-007207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To investigate the extent to which variation exists in the initiation rate of statin therapy for the primary prevention of cardiovascular disease between countries of the UK and between different regions within England. DESIGN Cohort study using data from a large UK primary care database. SETTING UK PARTICIPANTS 4,820,885 individuals from 554 general practices during the period 2004-2012. MAIN OUTCOME MEASURES Rate of statin therapy initiation per 1000 person-years. RESULTS Relative to a fixed English rate of 1 initiation per 1000 person-years and accounting for gender, age and social deprivation level, the rate was similar for Scotland at 0.92 (95% CI 0.84 to 1.00) and rates for Northern Ireland and Wales were higher at 1.40 (95% CI 1.20 to 1.62) and 1.18 (95% CI 1.05 to 1.32), respectively. Within England, the regions could be classified into three groups with respect to statin therapy initiation rates (relative to a rate of 1 initiation per 1000 person-years for London): the South Central 0.73 (95% CI 0.64 to 0.83), South West 0.80 (95% CI 0.71 to 0.91), East of England 0.81 (95% CI 0.71 to 0.94) and South East Coast 0.83 (95% CI 0.73 to 0.95); strategic health authorities had similar low rates followed by the East Midlands 0.88 (95% CI 0.73 to 1.05), West Midlands 0.96 (95% CI 0.84 to 1.09), North East 0.96 (95% CI 0.79 to 1.16), Yorkshire and Humber 0.97 (95% CI 0.81 to 1.17) and London strategic health authorities. North West England exhibited the highest rate of statin therapy initiation of 1.16 (95% CI 1.02 to 1.31). CONCLUSIONS Considerable variation in the rate of statin therapy initiation was observed between the four countries of the UK and between different geographical regions within England.
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Affiliation(s)
- Aidan G O'Keeffe
- Department of Statistical Science, University College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
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5
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Fleetcroft R, Schofield P, Ashworth M. Variations in statin prescribing for primary cardiovascular disease prevention: cross-sectional analysis. BMC Health Serv Res 2014; 14:414. [PMID: 25240604 PMCID: PMC4263070 DOI: 10.1186/1472-6963-14-414] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Statins are an important intervention for primary and secondary cardiovascular disease (CVD) prevention. We aimed to establish the variation in primary preventive treatment for CVD with statins in the English population. METHODS Cross sectional analyses of 6155 English primary care practices with 40,017,963 patients in 2006/7. Linear regression was used to model prescribing rates of statins for primary CVD prevention as a function of IMD (index of multiple deprivation) quintile, proportion of population from an ethnic minority, and age over 65 years. Defined Daily Doses (DDD) were used to calculate the numbers of patients receiving a statin. Statin prescriptions were allocated to primary and secondary prevention based on the prevalence of CVD and stroke. RESULTS We estimated that 10.5% (s.d.3.7%) of the registered population were dispensed a statin for any indication and that 6.3% (s.d. 3.0%) received a statin for primary CVD prevention. The regression model explained 21.2% of the variation in estimates of prescribing for primary prevention. Practices with higher prevalence of hypertension (β co-efficient 0.299 p <0.001) and diabetes (β co-efficient 0.566 p < 0.001) prescribed more statins for primary prevention. Practices with higher levels of ethnicity (β co-efficient-0.026 p <0.001), greater deprivation (β co-efficient -0.152 p < 0.001) older patients (β co-efficient -0.032 p 0.002), larger lists (β co-efficient -0.085, p < 0.001) and were more rural (β co-efficient -0.121, p0.026) prescribed fewer statins. In a small proportion of practices (0.5%) estimated prescribing rates for statins were so low that insufficient prescriptions were issued to meet the predicted secondary prevention requirements of their registered population. CONCLUSIONS Absolute estimated prescribing rates for primary prevention of CVD were 6.3% of the population. There was evidence of social inequalities in statin prescribing for primary prevention. These findings support the recent introduction of a financial incentive for primary prevention of CVD in England.
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Affiliation(s)
- Robert Fleetcroft
- />Department of Population Health and Primary Care, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ UK
| | - Peter Schofield
- />Department of Primary Care & Public Health Sciences, King’s College London, 9th Floor, Capital House, 42 Weston Street, London, SE1 3QD UK
| | - Mark Ashworth
- />Department of Primary Care & Public Health Sciences, King’s College London, 9th Floor, Capital House, 42 Weston Street, London, SE1 3QD UK
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Covvey JR, Johnson BF, Elliott V, Malcolm W, Mullen AB. An association between socioeconomic deprivation and primary care antibiotic prescribing in Scotland. J Antimicrob Chemother 2013; 69:835-41. [PMID: 24176983 DOI: 10.1093/jac/dkt439] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To evaluate the association between socioeconomic deprivation and antibiotic prescribing in Scotland. PATIENTS AND METHODS Data for dispensed antibiotic prescriptions written by general practitioners were obtained for all Scottish National Health Service boards from 2010 to 2012. Deprivation was assessed linking dispensing events to the Scottish Index of Multiple Deprivation (SIMD) score for the patient's datazone (neighbourhood area). The relationship between the deprivation area and antibiotic use (items per 1000 persons per day) was stratified according to the patient's age and sex and the antibiotic class dispensed. A multivariate Poisson regression model was used to formally test the associations. RESULTS Approximately 12 million prescription items during 2010-2012 were assessed. Patients in the most deprived SIMD quintile had an overall prescription rate that was 36.5% higher than those in the least deprived quintile. The effect of deprivation upon prescription rates was most pronounced for women aged 40-59 years, and for penicillins and metronidazole. CONCLUSIONS Deprivation was found to have a consistent association with increased rates of antibiotic prescribing in Scotland, which may have significant implications for antimicrobial stewardship and public health campaigns.
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Affiliation(s)
- Jordan R Covvey
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
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Owens T, Evangelou N, Whynes DK. Rationing and deprivation: disease-modifying therapies for multiple sclerosis in the United Kingdom. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:315-321. [PMID: 22270579 DOI: 10.1007/s10198-012-0378-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 01/10/2012] [Indexed: 05/31/2023]
Abstract
Unlike other industrialised countries, the UK deferred the routine introduction of disease-modifying therapies (DMTs) for multiple sclerosis (MS) in favour of an experiment. Between 2002 and 2005, MS sufferers were identified, were offered DMTs only if deemed suitable by their physicians, and were monitored thereafter to assess long-term outcomes. It has been demonstrated for other therapies that judgements about suitability to receive treatment are conditioned by the patient's deprivation status. We hypothesised that this would have been the case for DMTs also. Using individual patient data for samples in Nottingham and in Glasgow, we matched patients' postcodes of residence with deprivation scores and confirmed that patients from more deprived areas were less likely to have been prescribed DMTs. A more detailed analysis of the Nottingham data revealed two channels through which this outcome was effected. First, people from less-deprived areas were more likely to possess clinical characteristics, such as less severe disease severity and shorter duration of the disease, that enhanced their suitability for treatment. Second, the analysis of the clinical notes detailing patients' correspondence with the medical teams suggested that less-deprived people were more able to exercise a voice capable of influencing physicians' prescribing decisions.
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Affiliation(s)
- Trudy Owens
- School of Economics, University of Nottingham, Nottingham, UK
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Rashidian A, Russell I. Intentions and statins prescribing: can the theory of planned behaviour explain physician behaviour in following guideline recommendations? J Eval Clin Pract 2011; 17:749-57. [PMID: 21545379 DOI: 10.1111/j.1365-2753.2011.01690.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Few studies have assessed the utility of the Theory of Planned Behaviour (TPB) in explaining physicians' behaviour. This study uses the TPB for explaining physicians' implementation of guidelines' prescribing recommendations. METHODS We developed the questionnaire via conducting qualitative interviews and pilot study. A random sample of 155 general practitioners (GPs) in England participated in the study. Prescribing and practice data were collected from routine sources. We analysed the data using regression methods. RESULTS TPB explained 48% of variation in reported intentions to follow guidelines' prescribing recommendations. Attitude and perceived controls, but not subjective norms, were predictors of variation in intentions. TPB belief variables significantly explained variation in effective and efficient prescribing indicators (14% and 12% respectively). Normative, control and behavioural beliefs contributed to the models. Only for efficient prescribing, the TPB items retained their significance in presence of demographic variables. We found no significant relationship between intention and prescribing. CONCLUSIONS TPB helped understanding of GPs prescribing behaviour and their intentions to implement a clinical guideline. Beliefs (e.g. normative beliefs) were better predictors of behaviour than the composite scores for their corresponding higher-level construct (e.g. indirect subjective norm). TPB models should be tested alongside randomized trials to test the assumption of causality that change in beliefs ultimately results in change in behaviour.
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Affiliation(s)
- Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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9
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Lipkin SM, Chao EC, Moreno V, Rozek LS, Rennert H, Pinchev M, Dizon D, Rennert G, Kopelovich L, Gruber SB. Genetic variation in 3-hydroxy-3-methylglutaryl CoA reductase modifies the chemopreventive activity of statins for colorectal cancer. Cancer Prev Res (Phila) 2010; 3:597-603. [PMID: 20403997 DOI: 10.1158/1940-6207.capr-10-0007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Genetic variation in 3-hydroxy-3-methylglutaryl CoA reductase (HMGCR), the rate-limiting enzyme in cholesterol synthesis, modifies the effect of statins on serum cholesterol levels. Long-term use of statins is associated with a reduced risk of colorectal cancer (CRC) in some, but not all, studies. We genotyped variants in 40 candidate genes important for cholesterol synthesis and metabolism in a population-based case-control study of CRC involving 2,138 incident cases and 2,049 population-based controls. We identified a single-nucleotide polymorphism in the HMGCR gene that significantly modified the protective association between statins and CRC risk. Compared with nonusers, the unadjusted odds ratio of CRC among statin users with the A/A genotype of rs12654264 in HMGCR was 0.3 (95% confidence interval, 0.18-0.51) and among statin users with the T/T genotype was 0.66 (95% confidence interval, 0.41-1.06; P-interaction = 0.0012). This genetic variant (A/A genotype of rs12654264) also was associated with lower serum levels of low-density lipoprotein among all cases and controls. In colon cancer cell lines, the reduction in cholesterol levels after statin treatment was substantially stronger in cells carrying the A/A genotype, and this difference was related to alternative splicing involving the HMGCR statin-binding domain. We anticipate that these data may advance the development of personalized statin use for reducing the risk of cancer as well as cardiovascular disease among the approximately 25 million people currently using statins worldwide.
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Affiliation(s)
- Steven M Lipkin
- Department of Medicine, Weill Cornell School of Medicine, New York, New York 10021, USA.
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Wagner AC, Hann M, Ashcroft DM. Influence of population and general practice characteristics on prescribing of minor tranquilisers in primary care. Pharm Pract (Granada) 2010; 8:193-200. [PMID: 25126140 PMCID: PMC4127055 DOI: 10.4321/s1886-36552010000300007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 08/25/2010] [Indexed: 11/11/2022] Open
Abstract
UNLABELLED Prevalence of generalised anxiety disorders is widespread in Great Britain. Previous small-scale research has shown variations in minor tranquiliser prescribing, identifying several potential predictors of prescribing volume. OBJECTIVE This study aimed to investigate the relationship between general practice minor tranquiliser prescribing rates and practice population and general practice characteristics for all general practices in England. METHODS Multiple regression analysis of minor tranquiliser prescribing volumes during 2004/2005 for 8,291 English general practices with general practice and population variables obtained from the General Medical Services (GMS) statistics, Quality and Outcomes Framework (QOF), 2001 Census and 2004 Index of Multiple Deprivation (IMD). RESULTS The highest rates of minor tranquiliser prescribing were in areas with the greatest local deprivation while general practices situated in areas with larger proportions of residents of black ethnic origin had lower rates of prescribing. Other predictors of increased prescribing were general practices with older general practitioners and general practices with older registered practice populations. CONCLUSION Our findings show that there is wide variation of minor tranquilisers prescribing across England which has implications regarding access to treatment and inequity of service provision. Future research should determine the barriers to equitable prescribing amongst general practices serving larger populations of black ethnic origin.
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Affiliation(s)
- Andrew C Wagner
- Research Fellow, School of Pharmacy and Pharmaceutical Sciences, The University of Manchester . Manchester ( United Kingdom )
| | - Mark Hann
- Research Fellow, National Primary Care Research and Development Centre, The University of Manchester . Manchester ( United Kingdom )
| | - Daren M Ashcroft
- Reader in Medicines Usage and Safety, School of Pharmacy and Pharmaceutical Sciences, The University of Manchester . Manchester ( United Kingdom )
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McComb JM, Plummer CJ, Cunningham MW, Cunningham D. Inequity of access to implantable cardioverter defibrillator therapy in England: possible causes of geographical variation in implantation rates. Europace 2009; 11:1308-12. [DOI: 10.1093/europace/eup264] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Nguyen H, Tran A, Lipkin S, Fruehauf JP. Pharmacogenomics of Colorectal Cancer Prevention and Treatment. Cancer Invest 2009; 24:630-9. [PMID: 16982469 DOI: 10.1080/07357900600896281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pharmacogenomic tools are beginning to emerge that will provide guidance in the treatment and prevention of colorectal cancer. Significant individual genetic variation exists in drug metabolism of 5FU, capecitabine, irinotecan, and oxaliplatin that influences both the toxicity and efficacy of these agents. Recent FDA approval of genetic testing for mutations in the UGT1A1 gene that predict adverse reactions to irinotecan is ushering in a new era that will increasingly rely on genotyping to individualize treatment decisions for patients with cancer as well as for patients at high risk who may be candidates for chemoprevention agents. This review focuses on current knowledge regarding key mutations and polymorphisms which affect outcomes for colorectal cancer patients, as well as the pharmacogenetics of chemoprevention trials.
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Affiliation(s)
- Hoa Nguyen
- University of California Irvine Chao Family Comprehensive Cancer Center, Orange, California, USA
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Rasmussen JN, Gislason GH, Rasmussen S, Abildstrom SZ, Schramm TK, Køber L, Diderichsen F, Osler M, Torp-Pedersen C, Madsen M. Use of statins and beta-blockers after acute myocardial infarction according to income and education. J Epidemiol Community Health 2008; 61:1091-7. [PMID: 18000133 DOI: 10.1136/jech.2006.055525] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study the initiation of and long-term refill persistency with statins and beta-blockers after acute myocardial infarction (AMI) according to income and education. DESIGN AND SETTING Linkage of individuals through national registers of hospitalisations, drug dispensation, income and education. PARTICIPANTS 30 078 patients aged 30-74 years surviving first hospitalisation for AMI in Denmark between 1995 and 2001. MAIN OUTCOME MEASURES Initiation of statin or beta-blocker treatment (out-patient claim of prescriptions within 6 months of discharge) and refill persistency (first break in treatment lasting at least 90 days, and re-initiation of treatment after a break). RESULTS When simultaneously estimating the effect of income and education on initiation of treatment, the effect of education attenuated and a clear income gradient remained for both drugs. Among patients aged 30-64 years, high income (adjusted hazard ratio (HR) 1.27; 95% confidence interval (CI) 1.19-1.35) and medium income (HR 1.13; 95% CI 1.06-1.20) was associated with initiation of statin treatment compared with low income. The risk of break in statin treatment was lower for patients with high (HR 0.73; 95% CI 0.66-0.82) and medium (HR 0.82; 95% CI 0.74-0.92) income compared with low income, whereas there was a trend in the opposite direction concerning a break in beta-blocker treatment. There was no gradient in re-initiation of treatment. CONCLUSION Patients with low compared with high income less frequently initiated preventive treatment post-AMI, had worse long-term persistency with statins, but tended to have better persistency with beta-blockers. Low income by itself seems not to be associated with poor long-term refill persistency post-AMI.
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Affiliation(s)
- Jeppe N Rasmussen
- National Institute of Public Health, Øster Farimagsgade 5, DK-1399 Copenhagen K, Denmark.
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Strong M, Maheswaran R, Pearson T, Fryers P. A method for modelling GP practice level deprivation scores using GIS. Int J Health Geogr 2007; 6:38. [PMID: 17822545 PMCID: PMC2045089 DOI: 10.1186/1476-072x-6-38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Accepted: 09/06/2007] [Indexed: 12/04/2022] Open
Abstract
Background A measure of general practice level socioeconomic deprivation can be used to explore the association between deprivation and other practice characteristics. An area-based categorisation is commonly chosen as the basis for such a deprivation measure. Ideally a practice population-weighted area-based deprivation score would be calculated using individual level spatially referenced data. However, these data are often unavailable. One approach is to link the practice postcode to an area-based deprivation score, but this method has limitations. This study aimed to develop a Geographical Information Systems (GIS) based model that could better predict a practice population-weighted deprivation score in the absence of patient level data than simple practice postcode linkage. Results We calculated predicted practice level Index of Multiple Deprivation (IMD) 2004 deprivation scores using two methods that did not require patient level data. Firstly we linked the practice postcode to an IMD 2004 score, and secondly we used a GIS model derived using data from Rotherham, UK. We compared our two sets of predicted scores to "gold standard" practice population-weighted scores for practices in Doncaster, Havering and Warrington. Overall, the practice postcode linkage method overestimated "gold standard" IMD scores by 2.54 points (95% CI 0.94, 4.14), whereas our modelling method showed no such bias (mean difference 0.36, 95% CI -0.30, 1.02). The postcode-linked method systematically underestimated the gold standard score in less deprived areas, and overestimated it in more deprived areas. Our modelling method showed a small underestimation in scores at higher levels of deprivation in Havering, but showed no bias in Doncaster or Warrington. The postcode-linked method showed more variability when predicting scores than did the GIS modelling method. Conclusion A GIS based model can be used to predict a practice population-weighted area-based deprivation measure in the absence of patient level data. Our modelled measure generally had better agreement with the population-weighted measure than did a postcode-linked measure. Our model may also avoid an underestimation of IMD scores in less deprived areas, and overestimation of scores in more deprived areas, seen when using postcode linked scores. The proposed method may be of use to researchers who do not have access to patient level spatially referenced data.
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Affiliation(s)
- Mark Strong
- Rotherham Primary Care Trust, Oak House, Moorhead Way, Bramley, Rotherham, S66 1YY, UK
- Public Health GIS Unit, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Ravi Maheswaran
- Public Health GIS Unit, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Tim Pearson
- Public Health GIS Unit, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Paul Fryers
- Public Health Intelligence Unit, Doncaster Primary Care Trust, White Rose House, Ten Pound Walk, Doncaster, DN4 5DJ, UK
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15
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Ward PR, Noyce PR, St Leger AS. How equitable are GP practice prescribing rates for statins?: an ecological study in four primary care trusts in North West England. Int J Equity Health 2007; 6:2. [PMID: 17386118 PMCID: PMC1847516 DOI: 10.1186/1475-9276-6-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Accepted: 03/27/2007] [Indexed: 11/22/2022] Open
Abstract
Background There is a growing body of literature highlighting inequities in GP practice prescribing rates for a number of drug therapies. The small amount of research on statin prescribing has either focussed on variations rather than equity per se, been based on populations other than GP practices or has used cost-based prescribing rates. Aim To explore the equity of GP practice prescribing rates for statins, using the theoretical framework of equity of treatment (also known as horizontal equity or comparative need). Methods The study involved a cross-sectional secondary analysis in four primary care trusts (PCTs 1–4) in the North West of England, including 132 GP practices. Prescribing rates and health care needs indicators (HCNIs) were developed for all GP practices. Results Scatter-plots revealed large differences between individual GP practices, both within and between PCTs, in terms of the relationship between statin prescribing and healthcare need. In addition, there were large differences between GP practices in terms of the relationship between actual and expected prescribing rates for statins. Multiple regression analyses explained almost 30% of the variation in prescribing rates in the combined dataset, 25% in PCT1, 31% in PCT3, 51% in PC4 and 58% in PCT2. There were positive associations with variables relating to CHD hospital diagnoses and procedures and negative associations with variables relating to ethnicity, material deprivation, the proportion of patients aged over 75 years and single-handed GP practices. Conclusion Overall, this study found inequitable relationships between actual and expected prescribing rates, and possible inequities in statin prescribing rates on the basis of ethnicity, deprivation, single-handed practices and the proportion of patients aged over 75 years.
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Affiliation(s)
- Paul R Ward
- Department of Public Health, Flinders University, Adelaide, Australia
| | - Peter R Noyce
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester, UK
| | - Antony S St Leger
- School of Epidemiology and Health Sciences, University of Manchester, UK
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16
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Ashworth M, Lloyd D, Smith RS, Wagner A, Rowlands G. Social deprivation and statin prescribing: a cross-sectional analysis using data from the new UK general practitioner ‘Quality and Outcomes Framework’. J Public Health (Oxf) 2006; 29:40-7. [PMID: 17071815 DOI: 10.1093/pubmed/fdl068] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We aimed to study the relationship between the prescribing of lipid-lowering medication, social deprivation and other general practice characteristics. We conducted a cross-sectional survey of all general practices in England, 2004-05. For each practice, the following variables were obtained: standardized cost and volume data for lipid-lowering medication, descriptors of general practices, Index of Multiple Deprivation, 2004, ethnicity data from the 2001 Census and Quality and Outcomes Framework data. A regression model was constructed which explained 34.5% of the variation in statin prescribing by general practitioners. The most powerful predictors were higher social deprivation, higher prevalence of coronary heart disease and achievement of cholesterol targets for diabetics. Negative regression coefficients were demonstrated for the proportion of elderly patients in the practice and, to a lesser extent, for the proportion of south Asian and Afro-Caribbean patients. In conclusion, contrary to previous local studies, we found that statin prescribing was higher in more deprived communities, even after adjustment for increased disease prevalence and practice variables associated with deprivation. Statin prescribing was also independently associated with success at achieving cholesterol targets in established disease (secondary prevention). However, our findings suggest under-prescribing of statins to the elderly and possibly also to ethnic minorities.
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Affiliation(s)
- M Ashworth
- Department of General Practice and Primary Care, King's College London School of Medicine at Guy's, King's College and St Thomas' Hospitals, 5 Lambeth Walk, London SE11 6SP, UK.
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17
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Strong M, Maheswaran R, Pearson T. A comparison of methods for calculating general practice level socioeconomic deprivation. Int J Health Geogr 2006; 5:29. [PMID: 16820054 PMCID: PMC1524946 DOI: 10.1186/1476-072x-5-29] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 07/04/2006] [Indexed: 11/10/2022] Open
Abstract
Background A measure of the socioeconomic deprivation experienced by the registered patient population of a general practice is of interest because it can be used to explore the association between deprivation and a wide range of other variables measured at practice level. If patient level geographical data are available a population weighted mean area-based deprivation score can be calculated for each practice. In the absence of these data, an area-based deprivation score linked to the practice postcode can be used as an estimate of the socioeconomic deprivation of the practice population. This study explores the correlation between Index of Multiple Deprivation 2004 (IMD) scores linked to general practice postcodes (main surgery address alone and main surgery plus any branch surgeries), practice population weighted mean IMD scores, and practice level mortality (aged 1 to 75 years, all causes) for 38 practices in Rotherham UK. Results Population weighted deprivation scores correlated with practice postcode based scores (main surgery only, Pearson r = 0.74, 95% CI 0.54 to 0.85; main plus branch surgeries, r = 0.79, 95% CI 0.63 to 0.89). All cause mortality aged 1 to 75 correlated with deprivation (main surgery postcode based measure, r = 0.50, 95% CI 0.22 to 0.71; main plus branch surgery based score, r = 0.55, 95% CI 0.28 to 0.74); population weighted measure, r = 0.66, 95% CI 0.43 to 0.81). Conclusion Practice postcode linked IMD scores provide a valid proxy for a population weighted measure in the absence of patient level data. However, by using them, the strength of association between mortality and deprivation may be underestimated.
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Affiliation(s)
- Mark Strong
- Rotherham Primary Care Trust, Oak House, Moorhead Way, Bramley, Rotherham, S66 1YY, UK
| | - Ravi Maheswaran
- Public Health GIS Unit, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
| | - Tim Pearson
- Public Health GIS Unit, School of Health and Related Research, The University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK
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18
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Velasquez JL, Lipkin SM. What are SNPs and haplotypes and how will they help us manage the prevention of adult cancer? CURRENT COLORECTAL CANCER REPORTS 2006. [DOI: 10.1007/s11888-006-0016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Velasquez JL, Lipkin SM. What are SNPs and haplotypes and how will they help us manage the prevention of adult cancer? Curr Oncol Rep 2005; 7:475-9. [PMID: 16221385 DOI: 10.1007/s11912-005-0013-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Human genetic variation data are now publicly available on a large scale, from public and private discovery efforts. Datasets from the International Haplotype Map Consortium and Perlegen Sciences provide a level of knowledge about human genetic variation that is unprecedented. In combination with novel high-throughput genotyping technologies, these new resources will allow cancer prevention investigators to identify in a more precise way which genetic subsets of patients are likely to benefit most from chemoprevention and screening interventions.
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Affiliation(s)
- Jonathan L Velasquez
- Department of Medicine, Division of Hematology-Oncology, University of California, Irvine, 839 Medical Sciences Court, 2nd Floor, Sprague Hall--Lab 250, Irvine, CA 92697, USA
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Gorecka K, Linhartova A, Vlcek J, Tilser I. Cardiovascular drug utilisation and socio-economic inequalities in 20 districts of the Czech Republic. Eur J Clin Pharmacol 2005; 61:417-23. [PMID: 15983824 DOI: 10.1007/s00228-005-0929-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2004] [Accepted: 03/11/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To analyse whether there exists a socio-economic gradient in utilisation of cardiovascular drugs at the district level in the Czech Republic. METHODS The aggregated data on drug utilisation during the period 1997-2000, expressed in defined daily doses per 1000 inhabitants per day, were obtained from the General Health Insurance Company. Socio-economic characteristics of the districts in year 2000 (percentage of university-educated inhabitants, percentage of single-member households, number of ambulatory physicians per 10,000 inhabitants, unemployment rate and mean monthly income) were used as single unadjusted predictor variables. Partial correlation controlling for age in districts was used to analyse the relationship of cardiovascular disease (CVD) drug utilisation and several socio-economic variables. RESULTS There were considerable differences in the utilisation of CVD drugs within the districts studied. Significantly higher utilisation of dihydropyridine Ca-channel blockers and statins was found in the districts with a higher percentage of university-educated inhabitants and more ambulatory physicians. CVD drug utilisation (nitrates, fibrates, selective beta-blockers, verapamil and diltiazem and statins) correlated significantly with the percentage of single-member households. The five socio-economic variables explained more than 60% of the variability in use of dihydropyridine Ca-channel blockers, verapamil and diltiazem, ACE inhibitors and statins. CONCLUSION There exists a significant gradient in the utilisation of mainly newer CVD drug groups within districts of the Czech Republic that can be, at least partly, explained by social characteristics of the districts.
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Affiliation(s)
- Kvetoslava Gorecka
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University in Prague, Heyrovskeho 1203, 500 02 Hradec Kralove, Czech Republic.
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21
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Ward PR, Noyce PR, St Leger AS. Exploring the equity of GP practice prescribing rates for selected coronary heart disease drugs: a multiple regression analysis with proxies of healthcare need. Int J Equity Health 2005; 4:3. [PMID: 15701165 PMCID: PMC548940 DOI: 10.1186/1475-9276-4-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 02/08/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: There is a small, but growing body of literature highlighting inequities in GP practice prescribing rates for many drug therapies. The aim of this paper is to further explore the equity of prescribing for five major CHD drug groups and to explain the amount of variation in GP practice prescribing rates that can be explained by a range of healthcare needs indicators (HCNIs). METHODS: The study involved a cross-sectional secondary analysis in four primary care trusts (PCTs 1-4) in the North West of England, including 132 GP practices. Prescribing rates (average daily quantities per registered patient aged over 35 years) and HCNIs were developed for all GP practices. Analysis was undertaken using multiple linear regression. RESULTS: Between 22-25% of the variation in prescribing rates for statins, beta-blockers and bendrofluazide was explained in the multiple regression models. Slightly more variation was explained for ACE inhibitors (31.6%) and considerably more for aspirin (51.2%). Prescribing rates were positively associated with CHD hospital diagnoses and procedures for all drug groups other than ACE inhibitors. The proportion of patients aged 55-74 years was positively related to all prescribing rates other than aspirin, where they were positively related to the proportion of patients aged >75 years. However, prescribing rates for statins and ACE inhibitors were negatively associated with the proportion of patients aged >75 years in addition to the proportion of patients from minority ethnic groups. Prescribing rates for aspirin, bendrofluazide and all CHD drugs combined were negatively associated with deprivation. CONCLUSION: Although around 25-50% of the variation in prescribing rates was explained by HCNIs, this varied markedly between PCTs and drug groups. Prescribing rates were generally characterised by both positive and negative associations with HCNIs, suggesting possible inequities in prescribing rates on the basis of ethnicity, deprivation and the proportion of patients aged over 75 years (for statins and ACE inhibitors, but not for aspirin).
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Affiliation(s)
- Paul R Ward
- Section of Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Peter R Noyce
- School of Pharmacy and Pharmaceutical Sciences, University of Manchester, Manchester, UK
| | - Antony S St Leger
- Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK
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22
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Ward PR, Noyce PR, St Leger AS. Are GP practice prescribing rates for coronary heart disease drugs equitable? A cross sectional analysis in four primary care trusts in England. J Epidemiol Community Health 2004; 58:89-96. [PMID: 14729882 PMCID: PMC1732682 DOI: 10.1136/jech.58.2.89] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVE To analyse the associations between proxies of healthcare need and GP practice prescribing rates for five major coronary heart disease (CHD) drug groups. DESIGN Cross sectional secondary analysis. SETTING Four primary care trusts (PCTs 1-4) in the north west of England, encompassing 132 GP practices. RESULTS Prescribing rates were generally positively associated with the percentage of patients aged 55-74 years and PASS-PUs (regionally specific prevalence, age, and sex standardised prescribing units). However, the percentage of patients aged over 75 years showed a lack of association with prescribing rates in all PCTs other than PCT2. Correlations with the proportion of South Asian patients were generally negative, particularly in PCT2, PCT4, and the combined dataset. There was a general lack of association with deprivation proxies and SMRs for CHD, although there were negative associations with both variables in PCT4 and the combined dataset. Scatter plots showed that GP practices with similar prescribing rates had widely differing levels of comparative healthcare need, and GP practices with similar levels of healthcare need had widely differing prescribing rates. CONCLUSION GP prescribing rates in some PCTs were negatively associated with proxies of healthcare need based on patient age (patients aged over 75 years), ethnicity, levels of deprivation, and SMRs for CHD. As such, this study suggests that prescribing rates in these PCTs may be inequitable as they are not positively associated with healthcare need. This study may form the baseline for further studies to assess the effectiveness of the NSF for CHD in reducing the inequities in prescribing rates.
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Affiliation(s)
- P R Ward
- School of Social Science and Law, Sheffield Hallam University, Sheffield, UK.
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23
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Tonstad S, Rosvold EO, Furu K, Skurtveit S. Undertreatment and overtreatment with statins: the Oslo Health Study 2000-2001. J Intern Med 2004; 255:494-502. [PMID: 15049884 DOI: 10.1111/j.1365-2796.2004.01315.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We examined the prevalence and factors associated with use of cholesterol-lowering statins in the population. METHODS Demographic, medical, anthropometric and lifestyle data was obtained from 6233 men and 7521 women born in 1924/25, 1940/41, 1955 and 1960 that participated in the Oslo Health Study 2000-2001. A nonfasting blood sample was collected. RESULTS Of subjects with a heart attack, angina, stroke or diabetes 45% of men and 35% of women were taking a statin (P < 0.001). Of subjects with cardiovascular disease (CVD) or diabetes taking statins 61% of men and 40% of women achieved total serum cholesterol levels < or =5 mmol L(-1). The odds ratio for taking a statin was increased amongst subjects who also took antihypertensive drug(s) or acetylsalicylic acid, subjects with a family history of coronary heart disease (CHD) and women who had visited the general practitioner within the last year. Amongst presumed healthy subjects use of statins increased from about 1% in women aged 40-45 years, to 7% at age 60 and to 12% at age 75 whilst the corresponding figures for men were 3%, 8% and 9%, respectively. About 22% of men but <2% of women aged 60 who were not taking statins had a 10-year Framingham CHD risk score >20%. Determinants of statin use were similar to those amongst subjects with CVD or diabetes. CONCLUSION People with CVD or diabetes remain undertreated with statins, women more so than men. Use of other preventive drugs, the family history and recent contact with the general practitioner were the most important determinants of statin use in primary and secondary prevention. Amongst healthy subjects aged 60 or 75 years women received statins disproportionately to their low CHD risk compared with men.
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Affiliation(s)
- S Tonstad
- Department of Preventive Cardiology, Preventive Medicine Clinic, Ullevål University Hospital, Oslo, Norway.
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24
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Senior ML, Williams H, Higgs G. Morbidity, deprivation and drug prescribing: factors affecting variations in prescribing between doctors' practices. Health Place 2004; 9:281-9. [PMID: 14499213 DOI: 10.1016/s1353-8292(02)00061-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Analyses are reported of the prescribing quality and behaviour of 131 doctors' practices in a South Wales health authority during the first quarter of 1997. Prescribing of specific groups of drugs are examined, namely antidepressants; bronchodilators and inhaled corticosteroids for treating asthma; and oral antidiabetics and insulin for diabetes. It is hypothesised that the volumes and costs of prescriptions are determined by the characteristics of both doctors/practices (number and age of doctors; training and fundholding status of practices; single-handed practices and doctors per patient) and their patients (age; gender; ethnicity; deprivation). The health authority's population is characterised by substantial inequalities in wealth and health. Statistical analyses reveal the consistent influence of deprivation on prescribing costs and volumes, with the exception of items of insulin. Supply factors exert more selective influences. Thus, the number of doctors per practice and per patient has a positive influence on antidepressant prescribing; fundholding status is associated with lower costs for bronchodilator prescribing; and older doctors tend to prescribe more bronchodilators and oral antidiabetics. Residuals from the statistical analyses suggest further systematic influences, notably advice from hospital consultants, as well as more localised and less consistent effects.
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Affiliation(s)
- Martyn L Senior
- Department of City and Regional Planning, Cardiff University, Glamorgan Building, Cardiff, CF10 3WA, UK.
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25
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Ward PR, Noyce PR, St Leger AS. Developing prevalence-based prescribing units for analysing variations in general practitioner prescribing: a case study using statins. J Clin Pharm Ther 2003; 28:23-9. [PMID: 12605615 DOI: 10.1046/j.1365-2710.2003.00451.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To develop regionally specific prevalence-, age- and sex-standardized prescribing units (PASS-PUs) and to relate these to statin prescribing. DESIGN Cross-sectional. SETTING Ninety-four general practitioner (GP) practices within one health authority in the north-west of England. MAIN OUTCOME MEASURES Comparisons between specific therapeutic group age-sex-related prescribing units (STAR-PUs) and PASS-PUs for statin prescribing. RESULTS STAR-PUs and PASS-PUs were calculated for all GP practices and there was a high degree of correlation (Spearman's rank coefficient 0.88; P < 0.001). Using actual prescribing data for statins for a 12-month period, a statistically significant correlation was found between net ingredient cost per patient and STAR-PUs per patient (Spearman's rank coefficient 0.36; P < 0.01). However, the correlation between average daily quantities per patient and PASS-PUs per patient was not statistically significant. A scatter plot revealed a pattern whereby GP practices with high proportions of patients aged over 75 years exhibited low statin prescribing in relation to the expected prevalence of treated coronary heart disease (CHD) in their patient population. CONCLUSIONS Low weightings for patients aged over 75 years in calculating STAR-PUs lead to a much lower number of prescribing units within GP practice populations when compared with PASS-PUs. Current statin prescribing across GP practices in this study correlates with national prescribing cost patterns (as measured by STAR-PUs) although not with expected prevalence of treated CHD (as measured by PASS-PUs). PASS-PUs reflect prevalence of treated CHD and may therefore be used to monitor and predict GP prescribing arising from the implementation of the National Service Framework targets for CHD. In addition, PASS-PUs maybe derived for a wide range of therapeutic areas.
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Affiliation(s)
- P R Ward
- School of Social Sciences and Law, Sheffield Hallam University, Sheffield, UK.
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Gibson A, Asthana S, Brigham P, Moon G, Dicker J. Geographies of need and the new NHS: methodological issues in the definition and measurement of the health needs of local populations. Health Place 2002; 8:47-60. [PMID: 11852263 DOI: 10.1016/s1353-8292(01)00035-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
For a variety of purposes it is increasingly necessary to establish the health needs of local populations. Following a critique of existing proxies of need, this paper presents and evaluates an alternative which draws upon epidemiological evidence concerning the age, sex and social class distribution of morbidity in order to estimate the prevalence of specific conditions in designated populations. By way of demonstrating the insights to be gained through the use of these indicative prevalence rates, the paper considers the treatment of ischaemic heart disease in a sample of 539 practices and presents evidence regarding the significance of deprivation and rurality in determining health service use relative to needs.
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Affiliation(s)
- A Gibson
- Department of Geography, University of Exeter, Amory Building, Rennes Drive, Exeter EX4 4PN, UK.
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Packham C, Pearson J, Robinson J, Gray D. Use of statins in general practices, 1996-8: cross sectional study. BMJ (CLINICAL RESEARCH ED.) 2000; 320:1583-4. [PMID: 10845969 PMCID: PMC27405 DOI: 10.1136/bmj.320.7249.1583] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- C Packham
- Divisions of Public Health Medicine and Epidemiology, University Hospital Queen's Medical Centre, Nottingham NG7 2UH.
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