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Randomized Controlled Trial
. 2013 Jul 2:13:623.
doi: 10.1186/1471-2458-13-623.

Evaluating an implementation strategy in cardiovascular prevention to improve prescribing of statins in Germany: an intention to treat analysis

Heidemarie Keller, Oliver Hirsch  1 , Petra Kaufmann-Kolle, Tanja Krones, Annette Becker, Andreas C Sönnichsen, Erika Baum, Norbert Donner-Banzhoff
Affiliations
Randomized Controlled Trial

Evaluating an implementation strategy in cardiovascular prevention to improve prescribing of statins in Germany: an intention to treat analysis

Heidemarie Keller et al. BMC Public Health. .

Abstract

Background: The prescription of statins is an evidence-based treatment to reduce the risk of cardiovascular events in patients with elevated cardiovascular risk or with a cardiovascular disorder (CVD). In spite of this, many of these patients do not receive statins.

Methods: We evaluated the impact of a brief educational intervention in cardiovascular prevention in primary care physicians' prescribing behaviour regarding statins beyond their participation in a randomised controlled trial (RCT). For this, prescribing data of all patients > 35 years who were counselled before and after the study period were analysed (each n > 75,000). Outcome measure was prescription of Hydroxymethylglutaryl-CoA Reductase Inhibitors (statins) corresponding to patients' overall risk for CVD. Appropriateness of prescribing was examined according to different risk groups based on the Anatomical Therapeutic Chemical Classification System (ATC codes).

Results: There was no consistent association between group allocation and statin prescription controlling for risk status in each risk group before and after study participation. However, we found a change to more significant drug configurations predicting the prescription of statins in the intervention group, which can be regarded as a small intervention effect.

Conclusion: Our results suggest that an active implementation of a brief evidence-based educational intervention does not lead to prescription modifications in everyday practice. Physician's prescribing behaviour is affected by an established health care system, which is not easy to change.

Trial registration: ISRCTN71348772.

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Figures

Figure 1
Figure 1
Flow chart of participating GPs.
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References

    1. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B. et al. European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth joint task force of the european society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts) Eur J Cardiovasc Prev Rehabil. 2007;14(Suppl 2):S1–S113. - PubMed
    1. Ford I, Murray H, Packard CJ, Shepherd J, Macfarlane PW, Cobbe SM. Long-term follow-up of the west of scotland coronary prevention study. N Engl J Med. 2007;357(15):1477–1486. doi: 10.1056/NEJMoa065994. - DOI - PubMed
    1. Gotto AM Jr. Establishing the benefit of statins in low-to-moderate–risk primary prevention: the air force/texas coronary atherosclerosis prevention study (AFCAPS/TexCAPS) Atheroscler Suppl. 2007;8(2):3–8. doi: 10.1016/j.atherosclerosissup.2007.02.002. - DOI - PubMed
    1. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, McKillop JH, Packard CJ. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of scotland coronary prevention study group. N Engl J Med. 1995;333(20):1301–1307. doi: 10.1056/NEJM199511163332001. - DOI - PubMed
    1. van de Steeg-van Gompel CH, Wensing M, De Smet PA. Implementation of a pharmacist-led intervention to enhance statin prescribing for secondary prevention in primary care: a cluster randomized trial. Eur J Prev Cardiol. 2012;19(2):169–176. doi: 10.1177/1741826711398846. - DOI - PubMed

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