Abstract
BackgroundWe examine whether practices in areas with higher risks of CHD prescribe different levels of cardiovascular drugs and describe how they differ in GP and practice characteristics.MethodsPropensity score matching was used to identify two groups of practices in Scotland. The cases were in areas with 5% or more of the population in South Asian ethnic groups. The controls were in areas with less than 1% of the population in South Asian ethnic groups and were matched for other population characteristics.ResultsThe 39 case practices have lower prescribing rates than the matched controls for all heart disease drugs Significant different are found for six drugs (statins, ace Inhibitors, clopidogrel, thiazides, warfarin and digoxin. The differences range from 12.8% less for amlodipine to 43.9% for clopidogrel. The case practices also have lower prescribing costs than the unmatched group with the exception of ace inhibitors and aspirin. The highest prescribing costs for all drugs are found in the matched control group. The case practices are smaller than the controls, and have fewer GPs per 1,000 patients. Case practices have fewer quality markers and receive less in total resources, but have higher sums reimbursed to cover their employed staff costs.ConclusionPatients with higher risk of CHD tend to live in areas served by practices with lower prescribing rates and poorer structural characteristics. The scale of the differences in prescribing suggests that health care system factors rather than individual treatment decisions cause inequity in care. Identifying whether South Asian individuals are less likely to receive heart disease drugs than non South Asians requires individual-level prescribing data, which is currently not available in the UK.
Highlights
We examine whether practices in areas with higher risks of CHD prescribe different levels of cardiovascular drugs and describe how they differ in GP and practice characteristics
[11] This simple framework has been used as a basis to examine the equity of GP prescribing rates for statins and five major CHD drug groups focused around the equal treatment in equal need domain. [12,13] These papers are amongst a growing body of work in the UK, which have focused on equity of prescribing
The purpose of this paper is to explore the equity of prescribing for a range of heart disease drugs in Scotland
Summary
We examine whether practices in areas with higher risks of CHD prescribe different levels of cardiovascular drugs and describe how they differ in GP and practice characteristics. [11] This simple framework has been used as a basis to examine the equity of GP prescribing rates for statins and five major CHD drug groups focused around the equal treatment in equal need domain. [12,13] These papers are amongst a growing body of work in the UK, which have focused on equity of prescribing These studies have largely been confined to England and Wales. The purpose of this paper is to explore the equity of prescribing for a range of heart disease drugs in Scotland. We use examine the notion of equal treatment for people in equal need and how this relates to differences in equal access to health care
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