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Practice variation in a longitudinal perspective: a multilevel analysis of the prescription of simvastatin in general practices between 2003 and 2009

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Abstract

Purpose

The Dutch national guideline for Cardiovascular Risk Management advised in 2006 initiation of statin therapy in new patients with simvastatin. After the introduction of this guideline several measures were taken to increase the prescription of simvastatin in general practice. The aim of this paper is to describe the trend and interpractice variation in the relative share of simvastatin in statin prescription over a 7-year period (2003–2009) in Dutch general practices.

Methods

Data were used from the National Registration Network of General Practice (LINH) in the Netherlands. We used multilevel logistic regression analysis with individuals nested within practices. We evaluated the variance at different time points by the intra-class correlation (ICC).

Results

The share of simvastatin prescriptions of all statin prescriptions increased from 40% in 2003 to 82% in 2009. While the ICC was above 20% during the periods 2005 to 2007, it decreased rapidly from 25% in 2007 to only 9% in 2009.

Conclusion

Our results indicate that a combination of several intervention measures seems to have been successful. While it seems like the implementation of the guidelines alone had some effect, there was an additional effect when reimbursement measures were implemented. Furthermore, the practice seemed to have affected the adoption of the national CVRM guideline as the variation initially increased after the guideline implementation. By including information on both the proportion of simvastatin prescribed and interpractice variation, we achieved a more complete evaluation of how simvastatin prescription developed over time and how it was related to the different measures taken.

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Acknowledgements

We would like to thank the staff of LINH for their help in the data extraction and interpretation. This work was supported by the Dutch Ministry of Health.

Conflict of interest

None.

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Authors and Affiliations

  1. Center for Primary Health Care Research, Lund University & Region Skåne, CRC, ing 72, SUS, 205 02, Malmö, Sweden

    Henrik Ohlsson

  2. NIVEL, Netherlands Institute for Health Services Research, P.O. Box 156, 3500 BN, Utrecht, The Netherlands

    Marcia Vervloet & Liset van Dijk

  3. Unit of Social Epidemiology, Dept Clinical Science, Malmö, Lund University, CRC, ing 72, SUS, 205 02, Malmö, Sweden

    Henrik Ohlsson

Authors
  1. Henrik Ohlsson
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  2. Marcia Vervloet
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  3. Liset van Dijk
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Correspondence to Henrik Ohlsson.

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Ohlsson, H., Vervloet, M. & van Dijk, L. Practice variation in a longitudinal perspective: a multilevel analysis of the prescription of simvastatin in general practices between 2003 and 2009. Eur J Clin Pharmacol 67, 1205–1211 (2011). https://doi.org/10.1007/s00228-011-1082-8

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  • DOI: https://doi.org/10.1007/s00228-011-1082-8

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