Curtis Helen J, Walker Alex J, MacKenna Brian, Croker Richard, Goldacre Ben
The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Br J Gen Pract. 2020 Jul 30;70(697):e525-e533. doi: 10.3399/bjgp20X710873. Print 2020 Aug.
Since 2014 English national guidance recommends 'high-intensity' statins, reducing low-density lipoprotein (LDL) cholesterol by ≥40%.
To describe trends and variation in low-/medium-intensity statin prescribing and assess the feasibility of rapid prescribing behaviour change.
A retrospective cohort study using OpenPrescribing data from all 8142 standard NHS general practices in England from August 2010 to March 2019.
Statins were categorised as high- or low-/medium-intensity using two different thresholds, and the proportion prescribed below these thresholds was calculated. The authors plotted trends and geographical variation, carried out mixed-effects logistic regression to identify practice characteristics associated with breaching of guidance, and used indicator saturation to identify sudden prescribing changes.
The proportion of statins prescribed below the recommended 40% LDL-lowering threshold has decreased gradually from 80% in 2011/2012 to 45% in 2019; the proportion below a pragmatic 37% threshold decreased from 30% to 18% in 2019. Guidance from 2014 had minimal impact on trends. Wide variation was found between practices (interdecile ranges 20% to 85% and 10% to 30% respectively in 2018). Regression identified no strong associations with breaching of guidance. Indicator saturation identified several practices exhibiting sudden changes towards greater guideline compliance.
Breaches of guidance on choice of statin remain common, with substantial variation between practices. Some have implemented rapid change, indicating the feasibility of rapid prescribing behaviour change. This article discusses the potential for a national strategic approach, using data and evidence to optimise care, including targeted education alongside audit and feedback to outliers through services such as OpenPrescribing.
自2014年起，英国国家指南推荐使用“高强度”他汀类药物，可使低密度脂蛋白（LDL）胆固醇降低≥40%。
描述低/中强度他汀类药物处方的趋势和差异，并评估快速改变处方行为的可行性。
一项回顾性队列研究，使用了2010年8月至2019年3月期间英格兰8142家标准国民保健服务（NHS）全科诊所的OpenPrescribing数据。
使用两种不同阈值将他汀类药物分为高强度或低/中强度，并计算低于这些阈值的处方比例。作者绘制了趋势图和地理差异图，进行混合效应逻辑回归以确定与违反指南相关的诊所特征，并使用指标饱和度来识别处方的突然变化。
低于推荐的降低LDL 40%阈值开具的他汀类药物比例已从2011/2012年的80%逐渐降至2019年的45%；低于实用的37%阈值的比例在2019年从30%降至18%。2014年的指南对趋势影响极小。各诊所之间存在很大差异（2018年十分位数间距分别为20%至85%和10%至30%）。回归分析未发现与违反指南有强烈关联。指标饱和度确定了几家诊所表现出突然向更高指南依从性的变化。
他汀类药物选择方面违反指南的情况仍然普遍，各诊所之间存在很大差异。一些诊所已实现快速改变，表明快速改变处方行为是可行的。本文讨论了采用国家战略方法的潜力，利用数据和证据优化护理，包括有针对性的教育以及通过OpenPrescribing等服务对异常情况进行审核和反馈。
