TY - JOUR
T1 - Use of guideline-recommended drug therapy in patients undergoing percutaneous coronary intervention for stable coronary heart disease in Germany
T2 - A multilevel analysis of nationwide routine data
AU - Frank-Tewaag, Julia
AU - Bleek, Julian
AU - Horenkamp-Sonntag, Dirk
AU - Marschall, Ursula
AU - Zeymer, Uwe
AU - Donner-Banzhoff, Norbert
AU - Sundmacher, Leonie
N1 - Publisher Copyright:
©
PY - 2020/12/13
Y1 - 2020/12/13
N2 - Objectives To determine the prescription of guideline recommended drug therapy in patients with stable coronary heart disease (sCHD) prior to percutaneous coronary intervention (PCI) in Germany and to examine the role of patient characteristics and features of regional healthcare supply in a multilevel model. Design Secondary data analysis of factors associated with the prescription of guideline recommended drug therapy using a multilevel model to analyse regional-level effects, over and above the effects of patient-level demographic and health status. Setting Office-based prescriptions in the year prior to the invasive procedure. Participants A linked nationwide dataset from Germany's three largest statutory health insurance funds of all patients receiving PCI in the year 2016. Main outcome measures Patients' odds of receiving optimal medical therapy and symptom-oriented therapy within 1 year prior to PCI. Results 68.6% of patients received at least one lipid-lowering drug and one symptom-oriented therapy prior to PCI. 43.6% received at least two agents to control their symptoms. Patients who received treatment in accordance with the recommendations had a greater number of diagnosed risk factors, a more severe history of cardiac disease and used a higher volume of ambulatory office-based physician services. The prescriptions prevalence for the symptom-oriented therapies differed significantly between eastern and western Germany, with a higher prevalence in the eastern districts. Conclusions Guidelines can only provide decision-making corridors, and the applicability of recommendations must always be assessed on a case by case basis. Nevertheless, our analysis indicates that the prevalence of prescriptions in routine practice is subject to substantial variation and that conservative therapy options are not fully exhausted prior to PCI. This suggests that there might be room for improvement in the care of patients with sCHD.
AB - Objectives To determine the prescription of guideline recommended drug therapy in patients with stable coronary heart disease (sCHD) prior to percutaneous coronary intervention (PCI) in Germany and to examine the role of patient characteristics and features of regional healthcare supply in a multilevel model. Design Secondary data analysis of factors associated with the prescription of guideline recommended drug therapy using a multilevel model to analyse regional-level effects, over and above the effects of patient-level demographic and health status. Setting Office-based prescriptions in the year prior to the invasive procedure. Participants A linked nationwide dataset from Germany's three largest statutory health insurance funds of all patients receiving PCI in the year 2016. Main outcome measures Patients' odds of receiving optimal medical therapy and symptom-oriented therapy within 1 year prior to PCI. Results 68.6% of patients received at least one lipid-lowering drug and one symptom-oriented therapy prior to PCI. 43.6% received at least two agents to control their symptoms. Patients who received treatment in accordance with the recommendations had a greater number of diagnosed risk factors, a more severe history of cardiac disease and used a higher volume of ambulatory office-based physician services. The prescriptions prevalence for the symptom-oriented therapies differed significantly between eastern and western Germany, with a higher prevalence in the eastern districts. Conclusions Guidelines can only provide decision-making corridors, and the applicability of recommendations must always be assessed on a case by case basis. Nevertheless, our analysis indicates that the prevalence of prescriptions in routine practice is subject to substantial variation and that conservative therapy options are not fully exhausted prior to PCI. This suggests that there might be room for improvement in the care of patients with sCHD.
KW - coronary heart disease
KW - coronary intervention
KW - health services administration & management
KW - protocols & guidelines
KW - therapeutics
UR - http://www.scopus.com/inward/record.url?scp=85097979076&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-042886
DO - 10.1136/bmjopen-2020-042886
M3 - Article
C2 - 33318120
AN - SCOPUS:85097979076
SN - 2044-6055
VL - 10
JO - BMJ Open
JF - BMJ Open
IS - 12
M1 - e042886
ER -