University of Minnesota, Minneapolis, Minnesota, USA.
OptumLabs Visiting Fellow, Eden Prairie, Minnesota, USA.
Health Serv Res. 2021 Oct;56(5):919-931. doi: 10.1111/1475-6773.13630. Epub 2021 Feb 10.
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 Data Warehouse, a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data.
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 = 0.000).
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.
描述在临床证据逆转后，医生对 2 型糖尿病患者同时停用他汀类药物和贝特类药物的治疗方案的变化。
我们分析了来自 OptumLabs Data Warehouse 的 2007 年至 2015 年的索赔数据，这是一个具有去识别行政索赔和电子健康记录数据的纵向真实世界数据资产。
我们在 ACCORD 脂质试验公布前后，对接受他汀类药物治疗的 Medicare Advantage 和商业保险 2 型糖尿病患者的贝特类药物使用情况进行了建模，该试验发现，与他汀类药物单药治疗相比，贝特类药物和他汀类药物联合治疗并不能更有效地降低 2 型糖尿病患者的心血管事件发生率。我们使用医生随机效应和医生特征（如年龄和专业）来模拟贝特类药物使用趋势。
我们确定了具有一年连续保险参保、2 型糖尿病诊断和贝特类药物使用的患者-年-季度。我们根据评估和管理就诊以及降血糖药物的处方，确定对患者糖尿病治疗最负责的医生。
在试验前，商业保险患者的贝特类药物使用率每季度增加 0.12 个百分点（95%可信区间，0.10 至 0.14），而 Medicare Advantage 患者的贝特类药物使用率每季度增加 0.17 个百分点（95%可信区间，0.13 至 0.20）；然后，在试验后，商业保险患者的贝特类药物使用率每季度下降 0.16 个百分点（95%可信区间，-0.18 至 -0.15），而 Medicare Advantage 患者的贝特类药物使用率每季度下降 0.05 个百分点（95%可信区间，-0.06 至 -0.03）。然而，在试验后，45%的治疗商业保险患者的医生和 48%的治疗 Medicare Advantage 患者的医生在处方方面出现了积极的趋势。医生的特征并不能解释他们的差异（伪 R = 0.000）。
平均而言，医生在 ACCORD 脂质试验后减少了贝特类药物的处方。然而，许多医生在试验后增加了处方。可观察到的医生特征并不能解释处方的差异。未来的研究应该研究医生在其他停药环境中是否也有类似的差异。
