Understanding the effects of a decentralized budget on physicians' compliance with guidelines for statin prescription – a multilevel methodological approach

Abstract

Background: Official guidelines that promote evidence-based and cost-effective prescribing are of main relevance for obvious reasons. However, to what extent these guidelines are followed and their conditioning factors at different levels of the health care system are still insufficiently known.

Understanding adherence to therapeutic guidelines: a multilevel analysis of statin prescription in the Skaraborg Primary Care Database

“…In 2003 adherence to guidelines increased with age of the patients, but in 2005 there 9 were no differences between age groups. Older locum physicians presented a lower probability of prescribing a recommended statin than older GPs Model A in table 3, only includes two levels (i.e., patients and HCCs) and shows that in median a randomly selected patient's odds of receiving a recommended statin would increase of Scania [9]. However, the current analysis also adds information regarding the physician level.…”

“…Despite these recommendations several studies have demonstrated substantial and unexplained differences in the adherence with guidelines among physicians and among Health Care Centres (HCC) [8,9,12,13].These differences might express themselves as a clustering of similar prescription behavior among physicians at the same HCC and suggest the existence of local therapeutic traditions. Quantifying and understanding this variation is relevant for the planning of interventions aimed to improve the 4 quality of drug prescription.…”

“…In the Region of Skåne, Sweden, the implementation of a decentralised drug budget increased adherence to guidelines and promotes efficient drug therapy [9]. Similarly, in Skaraborg, Sweden the economical responsibility of tax-financed drug cost was transferred from the regional administration to the local HCC in the year 2003.…”

“…patients, physicians, HCCs) for understanding adherence with guidelines. Based on previous studies [9] our hypothesis was that the decentralized budget would result in an increased prevalence and a decreased variance between physicians and between HCCs, concerning prescription of recommended statins.…”

“…Moreover guidelines may also be an aid for prescribers that are hardly able to assimilate the increasing volume of new scientific information [1,[3][4][5]. Even though the investigation of adherence to guidelines is attracting increasing interest, it is still not sufficiently understood what and how factors at different levels of the health care organization condition adherence to guidelines [6][7][8][9].…”