Prescription Of Lipid-lowering Drugs Research Articles

Calidad del tratamiento farmacológico en pacientes con hiperlipemia de 4 áreas de salud

To calculate how suitable the lipid-lowering treatment prescribed for pensioners in primary care clinics in four health areas is. Cross-sectional descriptive study of quality of pharmacological treatment. Four primary care health districts, INSALUD, Madrid. 1125 patients registered with 49 doctors, chosen at random on the basis of three strata defined by the value of the lipid-lowering drug indicator of prescription. For a year, each doctor filled in a protocol of variables for each pensioner to whom he/she prescribed a lipid-lowering drug. An automated algorithm was designed to evaluate the suitability of the drugs treatment for each patient, according to scientific criteria including: cholesterol levels, LDL, age, and risk factors. Quality of prescription was finally measured for 1009 patients. The indication of the treatment was due to primary prevention in 65% of cases. 32% of patients were correctly treated. If LDL compliance was not demanded, the suitability figure rose to 77%. Drug treatment was more suitable when the doctor him/herself administered it (as against another doctor or a specialist; p = 0.001) or when the patient was on the list of the prescribing doctor (p < 0.0001). Proper indication was lower in patients over 74 (p < 0.0001). The quality of lipid-lowering drug prescription for pensioners in primary care clinics in four health districts, as a function of the criteria defined above, could be improved. LDL is the factor which most affects the procedure.

Indications for cholesterol-lowering medication: comparison of risk-assessment methods

Recommendations for the prescription of lipid-lowering drugs emphasise the importance of an assessment of absolute coronary heart disease (CHD) risk based on all risk factors, rather than simply the serum cholesterol concentration. If, however, the methods recommended for risk assessment are inaccurate, recommended prescribing will not occur. We compared several sets of guidelines for such treatment in a series of patients referred to a lipid clinic, to assess the difference in degree of risk of CHD at which lipid-lowering medication is recommended by each set of guidelines. For a series of 570 patients (50% men) without pre-existing clinical evidence of atherosclerosis referred to a lipid clinic, we compared the algorithms, charts, and tables used by the US National Cholesterol Education Program (NCEP), the joint guidelines of the European Society of Cardiology, the European Atherosclerosis Society, and the European Society of Hypertension, and the report of the UK Standing Medical Advisory Committee with the Framingham risk equation programmed into a computer. In 386 patients for whom the NCEP and UK guidelines could be compared, 62% of the men and 72% of the women met NCEP criteria for lipid-lowering medication, whereas only 9% of the men and less than 1% of the women met the UK criteria. The Framingham equation estimated a CHD risk of more than 3% per year in 22% of the men and 7% of the women, which shows that the UK tables underestimated CHD risk. European guidelines could be applied to only 261 patients, and were reasonably accurate in assessment of a CHD risk of 2% per year. Guidelines for the use of statin treatment in patients with CHD differ in their assessment of CHD risk. The method of risk assessment recommended in future guidelines for CHD prevention should be critically tested in relevant groups of patients.

Is prophylactic treatment after myocardial infarction evidence-based?

We aimed to evaluate the use of evidence-based prophylactic treatment after myocardial infarction on hospital discharge and in primary care after 1 year of hospitalization. We conducted a 1-year prospective study of all the patients discharged from a tertiary hospital who had been treated for myocardial infarction from January 1 to December 31 1995. Three hundred and eighty surviving patients were consecutively discharged from the hospital. Seventy per cent of patients were treated with aspirin, 45% with beta-blockers, 27% with calcium channel blockers, 26% with ACE inhibitors, 40% with nitrates and 8% with cholesterol-lowering drugs after discharge from the hospital. In primary care, prescription of lipid-lowering drugs increased to 17%, while prescription of beta-blockers decreased to 34%. ACE inhibitor prescriptions at discharge were clearly more common in patients with impaired ventricular function or heart failure (57%). According to the evidence, there is still potential for reducing the risk of a further ischaemic event or death in patients with MI, especially by increasing the use of beta-blockers and lipid-lowering drugs.

Lipid-lowering drug use must be based on evidence of cost effectiveness

The majority of lipid-lowering drug prescriptions dispensed in the Canadian province of British Columbia are for population groups for which there is no research evidence to support the use of such drugs. So says Dr Isabelle Savoie from the British Columbia Office of Health Technology Assessment, Vancouver, Canada. She made this comment at the 14th Annual Meeting of the International Society of Technology Assessment in Health Care (ISTAHC) [Ottawa, Canada; June 1998] during a presentation of pharmacoeconomic studies of lipid-lowering drug therapy. The preliminary results of Dr Savoie’s study1and those of other of presenters at the session are discussed below.

Persistence of use of lipid-lowering medications: a cross-national study.

Although clinical trials have demonstrated the benefits of lipid-lowering therapy, little is known about how these drugs are prescribed or used in the general population. To estimate predictors of persistence with therapy for lipid-lowering drug regimens in typical populations of patients in the United States and Canada. A cohort study defining all prescriptions filled for lipid-lowering drugs during 1 year, as well as patients' demographic and clinical characteristics. New Jersey's Medicaid and Pharmacy Assistance for the Aged and Disabled programs and Quebec's provincial medical care program. All continuously enrolled patients older than 65 years who filled 1 or more prescriptions for lipid-lowering drugs (N = 5611 in the US programs, and N = 1676 drawn from a 10% sample in Quebec). Proportion of days during the study year for which patients had filled prescriptions for lipid-lowering drugs; predictors of good vs poor persistence with therapy. In both populations, patients failed to fill prescriptions for lipid-lowering drugs for about 40% of the study year. Persistence rates with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors were significantly higher than those seen with cholestyramine (64.3% vs 36.6% of days with drug available, respectively). Patients with hypertension, diabetes, or coronary artery disease had significantly higher rates of persistence with lipid-lowering regimens. In New Jersey, multivariable analysis indicated that the poorest patients (those enrolled in Medicaid) had lower rates of drug use than less indigent patients (those enrolled in Pharmacy Assistance for the Aged and Disabled) after adjusting for possible confounders, despite virtually complete drug coverage in both programs. When rates of use were measured in the US population for the 5 years following the study year, only 52% of surviving patients who were initially prescribed lipid-lowering drugs were still filling prescriptions for this drug class. In all populations studied, patients who were prescribed lipid-lowering drug regimens remained without filled prescriptions for over a third of the study year on average. Rates of persistence varied substantially with choice of agent prescribed, comorbidity, and socioeconomic status, despite universal coverage of prescription drug costs. After 5 years, about half of the surviving original cohort in the United States had stopped using lipid-lowering therapy altogether.

PCV5 Pharmaceutical Costs of Patient Non-Adherence to Lipid-Lowering Drug Therapy

Lipid-lowering (LL) drugs decrease morbidity and mortality due to coronary heart disease (CHD). Among CHD patients, some LL drugs also decrease overall mortality. To realize the therapeutic benefits, LL drugs must be used for at least two years. A previous study in Saskatchewan showed that patient adherence to LL drugs is poor. OBJECTIVES: The objective of this study is to quantify the direct costs of non-adherence to LL drug therapy. The first phase will focus on pharmaceutical costs. Subsequent analyses will include physician services and hospitalization costs. METHODS: The government of Saskatchewan maintains comprehensive, linkable databases on health services provided to the population of approximately one million residents. Eligible beneficiaries with one or more outpatient prescriptions for LL drugs between 1989 and 1996 were identified. Exposure time was calculated for each subject. Cost analyses were conducted from the societal perspective. RESULTS: LL drugs were commonly used in Saskatchewan during the study period: 629,728 prescriptions for LL drugs were dispensed to 32,758 people (approximately 3% of the population). Statins were the most widely used LL drugs, followed by gemfibrozil and cholestyramine. On average, subjects were exposed to LL drugs for 1.7 years. Only 35% of LL drug users were exposed for two years or longer. The total cost of LL prescriptions during the study period was $44.6 million CAN. However, $6.9 million (15%) of these costs were for prescriptions dispensed to people who used LL drugs for less than two years. DISCUSSION: Poor patient adherence to LL drugs results in substantial wastage of pharmaceutical expenditures. Future analyses will focus on outcomes associated with non-adherence and their impact on overall physician service, hospitalization and drug costs.

Effects of “group detailing” on the prescribing of lipid-lowering drugs: A randomized controlled trial in Swedish primary care

The objective was to study the effect of “academic group detailing” on the prescribing of lipid-lowering drugs in Swedish primary care. A randomized controlled trial was conducted, randomization being by group. Groups of doctors at 134 community health centres were randomly allocated to an intervention and a control group. The 67 intervention health centres were offered four sessions, conducted by a pharmacist, with group information on guidelines for the management of hyperlipidaemia. The number of prescriptions of lipid-lowering drugs per month increased in the intervention health centres and the increase was statistically different from the corresponding change in the control health centres among women in the age group 30–65 years ( p = 0.03). The prescription of first-line lipid-lowering drugs increased by 20% in the intervention health centres ( p = 0.03). “Academic group detailing” by pharmacists to primary care doctors can be an effective method for influencing prescribing practices.