Guidelines accompanied by changes in reimbursement rules. Effects on lipid-lowering drug prescribing.
OBJECTIVE
To analyse the effect of guidelines accompanied by changes in reimbursement rules for the prescription of lipid-lowering drugs (LLDs).


METHODS
Observational study focusing on LLD use before (1994-98) and after an intervention (1999).


METHODS
Guidelines were developed by the Danish College of General Practitioners and focused on prevention of cardiovascular heart disease (CHD). Guidelines were sent out and changes in reimbursement took place in December 1998. Prescriptions for LLDs were extracted from a population-based prescription database (Odense University Pharmacoepidemiological Database, OPED) covering 10% of the Danish population (470,000 inhabitants).


METHODS
Incidence rate and 1 year prevalence rate (annual prevalence) of LLD use.


RESULTS
The incidence of LLD use increased significantly in the year following the intervention. Incidence rate ratio (after/before) was 1.43 (CI 1.35-1.52). The annual prevalence of LLD use in the population increased by 0.4% after the intervention (0.2% before). The corresponding figure for patients with diabetes mellitus (treated with insulin or oral anti-diabetics) was 2.3% after the intervention (1.2% before), and for patients with CHD (treated with vasodilators) 8.1% after the intervention (5.0% before).


CONCLUSIONS
Guidelines accompanied by a change in reimbursement rules had a significant influence on the prescribing of lipid-lowering drugs.
Bjerrum
L
L
Research Unit of General Practice, University of Southern Denmark, Odense. lbjerrum@health.sdu.dk
Larsen
J
J
Kragstrup
J
J
D000368:Aged; D003327:Coronary Disease / Q000209:etiology / Q000517:prevention & control; D003718:Denmark; D048909:Diabetes Complications; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012051:Reimbursement Mechanisms / Q000458:organization & administration*
D000960:Hypolipidemic Agents