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
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