title: Discharge prescriptions following admission for acute myocardial infarction at tertiary care and community hospitals in Quebec.
abstract: BACKGROUND
  Many physicians are not adhering to the recommendations found in evidence-based guidelines for the treatment of acute myocardial infarction (AMI). Physicians who practise in tertiary care settings may show better adherence to guideline recommendations than physicians who practise in other settings.
  
  
  OBJECTIVE
  To determine whether there is an association between the practice setting of admission for AMI and discharge prescriptions for cardiac drugs recommended in evidence-based guidelines.
  
  
  METHODS
  Discharge prescription data from a prospective cohort of patients with AMI admitted at five tertiary care (n=250) and five community hospitals (n=331) in Quebec from December 1996 to November 1998 were examined.
  
  
  RESULTS
  The proportions of patients who were prescribed recommended drugs at tertiary care hospitals compared with those at community hospitals were as follows: beta-blockers (78% versus 74%, respectively; 95% CI around the difference - 4% to 11%), lipid-lowering drugs (45% versus 39%, respectively; 95% CI - 2% to 15%) and angiotensin-converting enzyme (ACE) inhibitors (44% versus 57%, respectively; 95% CI - 22% to - 5%). In adjusted analyses, practice setting was not associated with the prescription of beta-blockers (odds ratio [OR] for tertiary care 1.36; 95% CI 0.82 to 2.24) or lipid-lowering drugs (OR for tertiary care 1.06; 95% CI 0.67 to 1.68). However, tertiary care admission reduced the likelihood of ACE inhibitor prescription (OR 0.50; 95% CI 0.32 to 0.77). This association may have been due to the increased likelihood of ACE inhibitor prescription for patients with hypertension at community hospitals (OR 2.13; 95% CI 1.23 to 3.67). The results also showed that older patients were less likely to be prescribed beta-blockers or lipid-lowering drugs, women were less likely to be prescribed beta-blockers and patients with diabetes mellitus were less likely to be prescribed lipid-lowering drugs (OR 0.45; 95% CI 0.23 to 0.89).
  
  
  CONCLUSIONS
  No strong association was found between the practice setting of admission for AMI and discharge prescriptions for cardiac drugs recommended in evidence-based guidelines. Prescription rates for recommended drugs were high, yet results suggest that there is room for improvement with regard to patients with diabetes, women and older patients.
authors.affiliation: Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Canada.
authors.forename: C A
authors.initials: CA
authors.lastname: Beck
authors.forename: C
authors.initials: C
authors.lastname: Lauzon
authors.forename: M J
authors.initials: MJ
authors.lastname: Eisenberg
authors.forename: T
authors.initials: T
authors.lastname: Huynh
authors.forename: D
authors.initials: D
authors.lastname: Dion
authors.forename: R
authors.initials: R
authors.lastname: Roux
authors.forename: N
authors.initials: N
authors.lastname: Racine
authors.forename: S
authors.initials: S
authors.lastname: Carignan
authors.forename: J G
authors.initials: JG
authors.lastname: Diodati
authors.forename: F
authors.initials: F
authors.lastname: Charbonneau
authors.forename: C
authors.initials: C
authors.lastname: Lévesque
authors.forename: J
authors.initials: J
authors.lastname: Pouliot J
authors.forename: L
authors.initials: L
authors.lastname: Pilote L
mesh_terms: D018674:Adrenergic Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004363:Drug Utilization; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D006764:Hospitals, Community; D006785:Hospitals, University; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011792:Quebec
chemical_list: D018674:Adrenergic Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D000960:Hypolipidemic Agents