title: Physician, organisational and patient characteristics explaining the use of angiotensin converting enzyme inhibitors in heart failure treatment: a multilevel study.
abstract: OBJECTIVE
  Heart failure treatment in general practice is not concordant with guideline recommendations. Insight into the key determinants at different levels is needed in order to improve care. The aim was to assess the influence of physician, organisational and patient characteristics on the treatment of chronic heart failure with angiotensin converting enzyme (ACE) inhibitors in primary care.
  
  
  METHODS
  Physician and organisational data were collected by means of a questionnaire. Patient and treatment data were extracted from electronic medical records. Multilevel analysis was used to assess the effect of physician, organisational and patient factors on the treatment with ACE inhibitors in terms of prescription rate and dosage.
  
  
  RESULTS
  Data from 735 randomly selected heart failure patients were extracted from the medical records of 95 general practitioners (GPs). Patients who visited a cardiologist or an outpatient heart failure clinic were more likely to receive an ACE inhibitor. In addition, relatively young patients, male patients and patients already using a diuretic were more likely to receive an ACE inhibitor. Furthermore, male patients and patients with concomitant hypertension were more likely to receive a higher dose of ACE inhibitor. GP characteristics did not determine whether CHF patients received ACE inhibitor treatment.
  
  
  CONCLUSIONS
  The differences in ACE inhibitor prescribing seem to be linked more to patient than physician characteristics. Interventions to improve the quality of care should therefore focus on the treatment of specific patient groups. Specialised care, particularly through outpatient clinics, could lead to improvement in the use of ACE inhibitors.
authors.affiliation: Department of Clinical Pharmacology, University of Groningen, A. Deusinglaan 1, 9713AV, Groningen, The Netherlands.
authors.forename: Willeke N
authors.initials: WN
authors.lastname: Kasje
authors.forename: Petra
authors.initials: P
authors.lastname: Denig
authors.forename: Roy E
authors.initials: RE
authors.lastname: Stewart
authors.forename: Pieter A
authors.initials: PA
authors.lastname: de Graeff
authors.forename: Flora M
authors.initials: FM
authors.lastname: Haaijer-Ruskamp
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010361:Patients; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D011364:Professional Practice / Q000458:organization & administration*; D012737:Sex Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors