Keller Heidemarie, Hirsch Oliver, Kaufmann-Kolle Petra, Krones Tanja, Becker Annette, Sönnichsen Andreas C, Baum Erika, Donner-Banzhoff Norbert
Department of General Practice/Family Medicine, Philipps University of Marburg, Karl-von-Frisch-Strasse 4, Marburg, 35043, Germany.
BMC Public Health. 2013 Jul 2;13:623. doi: 10.1186/1471-2458-13-623.
The prescription of statins is an evidence-based treatment to reduce the risk of cardiovascular events in patients with elevated cardiovascular risk or with a cardiovascular disorder (CVD). In spite of this, many of these patients do not receive statins.
We evaluated the impact of a brief educational intervention in cardiovascular prevention in primary care physicians' prescribing behaviour regarding statins beyond their participation in a randomised controlled trial (RCT). For this, prescribing data of all patients > 35 years who were counselled before and after the study period were analysed (each n > 75,000). Outcome measure was prescription of Hydroxymethylglutaryl-CoA Reductase Inhibitors (statins) corresponding to patients' overall risk for CVD. Appropriateness of prescribing was examined according to different risk groups based on the Anatomical Therapeutic Chemical Classification System (ATC codes).
There was no consistent association between group allocation and statin prescription controlling for risk status in each risk group before and after study participation. However, we found a change to more significant drug configurations predicting the prescription of statins in the intervention group, which can be regarded as a small intervention effect.
Our results suggest that an active implementation of a brief evidence-based educational intervention does not lead to prescription modifications in everyday practice. Physician's prescribing behaviour is affected by an established health care system, which is not easy to change.
ISRCTN71348772.
他汀类药物的处方是一种基于证据的治疗方法，用于降低心血管风险升高或患有心血管疾病（CVD）患者发生心血管事件的风险。尽管如此，许多此类患者并未接受他汀类药物治疗。
我们评估了一项简短的心血管预防教育干预对基层医疗医生在参与随机对照试验（RCT）之外关于他汀类药物处方行为的影响。为此，分析了研究期间前后接受咨询的所有35岁以上患者的处方数据（每组n>75000）。结果指标是与患者CVD总体风险相对应的羟甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）的处方。根据解剖治疗化学分类系统（ATC代码），针对不同风险组检查处方的适当性。
在参与研究前后，每组风险组中，组分配与控制风险状态的他汀类药物处方之间没有一致的关联。然而，我们发现干预组中预测他汀类药物处方的药物配置发生了更显著的变化，这可被视为一种小的干预效果。
我们的结果表明，在日常实践中积极实施简短的基于证据的教育干预不会导致处方改变。医生的处方行为受到既定医疗保健系统的影响，而该系统不易改变。
ISRCTN71348772。
