Effects of Guideline and Formulary Changes on Statin Prescribing in the Veterans Affairs
Autor: | Eve A. Kerr, Mandi L. Klamerus, Adam A. Markovitz, Jeremy B. Sussman, Timothy P. Hofer, Rob Holleman |
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Jazyk: | angličtina |
Rok vydání: | 2017 |
Předmět: |
Adult
Male medicine.medical_specialty Statin medicine.drug_class Atorvastatin 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans 030212 general & internal medicine Formulary Best of the 2017 AcademyHealth Annual Research Meeting Practice Patterns Physicians' Veterans Affairs Aged Retrospective Studies business.industry Health Policy Interrupted Time Series Analysis Guideline American Heart Association Statin treatment Middle Aged Formularies Hospital as Topic Confidence interval Drug Utilization United States United States Department of Veterans Affairs Emergency medicine Practice Guidelines as Topic Extraction methods Female sense organs Guideline Adherence Hydroxymethylglutaryl-CoA Reductase Inhibitors business medicine.drug |
Popis: | OBJECTIVE To compare the effects of two sequential policy changes-the addition of a high-potency statin to the Department of Veterans Affairs (VA) formulary and the release of the American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines-on VA provider prescribing. DATA SOURCES/STUDY SETTING Retrospective analysis of 1,100,682 VA patients, 2011-2016. STUDY DESIGN Interrupted time-series analysis of changes in prescribing of moderate-to-high-intensity statins among high-risk patients and across high-risk subgroups. We also assessed changes in prescribing of atorvastatin and other statin drugs. We estimated marginal effects (ME) of formulary and guideline changes by comparing predicted and observed statin use. DATA COLLECTION/EXTRACTION METHODS Data from VA Corporate Data Warehouse. PRINCIPAL FINDINGS The use of moderate-to-high-intensity statins increased by 2 percentage points following the formulary change (ME, 2.4, 95% confidence interval [CI], 2.2 to 2.6) and less than 1 percentage point following the guideline change (ME, 0.8, 95% CI, 0.6 to 0.9). The formulary change led to approximately a 12 percentage-point increase in the use of moderate-to-high-intensity atorvastatin (ME, 11.5, 95% CI, 11.3 to 11.6). The relatively greater provider response to the formulary change occurred across all patient subgroups. CONCLUSIONS Addition of a high-potency statin to formulary affected provider prescribing more than the ACC/AHA guidelines. |
Databáze: | OpenAIRE |
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