Variabilidad en la utilización de antihipertensivos entre las zonas básicas de salud de la Comunidad Valenciana

Abstract

Objectives To estimate consumption of five subgroups of antihypertensive drugs by primary care areas and to analyze its variation. Methods We performed an ecological, descriptive study of antihypertensive consumption in 239 primary care areas in the autonomous region of Valencia in 2005 followed by analysis of the variability observed. The 239 primary care areas were studied by descriptive analysis of dispensation [defined daily dose (DDD) per 1,000 inhabitants/day in pensioners (DDD/1000p/day) and in the active population (DDD/1000a/day)] and standardized consumption ratios. Small-area variation analysis was used to analyze the observed variability. Associations among dispensations of the distinct therapeutic subgroups were also analyzed. Results Overall antihypertensive use in the autonomous region of Valencia in 2005 was 235.6 DDD/1000/day. This consumption was concentrated in pensioners (800 DDD/1000p/day vs. 73 DDD/1000a/day). Consumption of antihypertensive subgroups oscillated from 442 DDD/1000p/day for drugs with action on the renin-angiotensin system to 32 DDD/1000p/day for doxazosin. The active population showed similar patterns. Variation in consumption was moderate, with coefficients of variation from 0.20 to 0.40 (slightly greater for the active population). Associations among dispensations of the different therapeutic subgroups were strong. Conclusions This study shows major variations in the overall consumption of antihypertensive drugs among primary care areas of the autonomous region of Valencia. These results suggest that variation may be associated with problems of underutilization in areas with lower consumption.