Physician variation in the de-adoption of ineffective statin and fibrate therapy.
Aged
Diabetes Mellitus, Type 2
/ drug therapy
Drug Therapy, Combination
Drug Utilization
Female
Fibric Acids
/ administration & dosage
Guideline Adherence
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
/ administration & dosage
Hypoglycemic Agents
/ therapeutic use
Hypolipidemic Agents
/ administration & dosage
Longitudinal Studies
Male
Medicare Part C
/ statistics & numerical data
Middle Aged
Practice Guidelines as Topic
Practice Patterns, Physicians'
/ statistics & numerical data
Risk Factors
United States
Type 2
diabetes mellitus
fibric acids
hydroxymethylglutaryl-CoA reductase inhibitors
longitudinal studies
physicians
Journal
Health services research
ISSN: 1475-6773
Titre abrégé: Health Serv Res
Pays: United States
ID NLM: 0053006
Informations de publication
Date de publication:
10 2021
10 2021
Historique:
pubmed:
12
2
2021
medline:
15
12
2021
entrez:
11
2
2021
Statut:
ppublish
Résumé
To describe physicians' variation in de-adopting concurrent statin and fibrate therapy for type 2 diabetic patients following a reversal in clinical evidence. We analyzed 2007-2015 claims data from OptumLabs We modeled fibrate use among Medicare Advantage and commercially insured type 2 diabetic statin users before and after the publication of the ACCORD lipid trial, which found statins and fibrates were no more effective than statins alone in reducing cardiovascular events among type 2 diabetic patients. We modeled fibrate use trends with physician random effects and physician characteristics such as age and specialty. We identified patient-year-quarters with one year of continuous insurance enrollment, type 2 diabetes diagnoses, and fibrate use. We designated the physician most responsible for patients' diabetes care based on evaluation and management visits and prescriptions of glucose-lowering drugs. Fibrate use increased by 0.12 percentage points per quarter among commercial patients (95% CI, 0.10 to 0.14) and 0.17 percentage points per quarter among Medicare Advantage patients (95% CI, 0.13 to 0.20) before the trial and then decreased by 0.16 percentage points per quarter among commercial patients (95% CI, -0.18 to -0.15) and 0.05 percentage points per quarter among Medicare Advantage patients (95% CI, -0.06 to -0.03) after the trial. However, 45% of physicians treating commercial patients and 48% of physicians treating Medicare Advantage patients had positive trends in prescribing following the trial. Physicians' characteristics did not explain their variation (pseudo R On average, physicians decreased fibrate prescribing following the ACCORD lipid trial. However, many physicians increased prescribing following the trial. Observable physician characteristics did not explain variations in prescribing. Future research should examine whether physicians vary similarly in other de-adoption settings.
Identifiants
pubmed: 33569804
doi: 10.1111/1475-6773.13630
pmc: PMC8522575
doi:
Substances chimiques
Fibric Acids
0
Hydroxymethylglutaryl-CoA Reductase Inhibitors
0
Hypoglycemic Agents
0
Hypolipidemic Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
919-931Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NHLBI NIH HHS
ID : R56 HL130496
Pays : United States
Organisme : AHRQ HHS
ID : T32 HS000036
Pays : United States
Organisme : AHRQ HHS
ID : R01 HS025164
Pays : United States
Organisme : NIA NIH HHS
ID : P01 AG005842
Pays : United States
Informations de copyright
© 2021 Health Research and Educational Trust.
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