How to best assess quality of drug treatment in patients with heart failure
| Autor: | Björn Wettermark, Ramin Zarrinkoub, Per Wändell, Sven-Erik Johansson, Märit Mejhert, Thomas Kahan |
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| Rok vydání: | 2015 |
| Předmět: |
Drug Utilization
Adult Male medicine.medical_specialty Cross-sectional study Angiotensin-Converting Enzyme Inhibitors 030204 cardiovascular system & hematology Pharmacology 03 medical and health sciences Drug treatment Angiotensin Receptor Antagonists 0302 clinical medicine Internal medicine Health care medicine Humans Pharmacology (medical) 030212 general & internal medicine Medical diagnosis Socioeconomic status Aged Quality of Health Care Aged 80 and over Heart Failure Sweden business.industry General Medicine Middle Aged medicine.disease Comorbidity Cross-Sectional Studies Heart failure Practice Guidelines as Topic Female Self Report business |
| Zdroj: | European journal of clinical pharmacology. 72(8) |
| ISSN: | 1432-1041 |
| Popis: | The proportion of patients with heart failure (HF) treated with angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) is frequently used as quality indicator. This study aimed to compare agreement between different methods of calculating this quality indicator. In addition, characteristics for patients and care providers associated with a high proportion treated with ACEI or ARB were analyzed. This Swedish cross-sectional register-based study was conducted in the Stockholm region (2.1 million inhabitants). The proportion of patients with HF treated with ACEI or ARB was calculated by different methods applied on an administrative database on healthcare consumption, diagnoses, and dispensed drugs and by self-reported data from all primary care centers in the region. A total of 32,677 patients recorded with a HF diagnosis 2008–2012 and alive July–December 2012 were identified. The proportion treated with ACEI or ARB varied depending on observation period and care provider included (range register 52–74 %). There was a large variation between different primary care centers (range register 36–88 %, range self-reported 8–100 %) and a poor agreement between methods (Bland-Altman; rhoc range 0.07–0.23). Predictors for high proportion treated were low age, high socioeconomic status, cardiovascular comorbidity, and diagnosis recorded both in primary care and in hospitals. There is poor agreement between different methods to evaluate adherence to guidelines for drug treatment in HF. Differences between practices concerning patient age, socioeconomic status, comorbidity, and care given by different providers should be taken into account in quality assessment. |
| Databáze: | OpenAIRE |
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