Potential savings without compromising the quality of care.
OBJECTIVE
This study was designed to analyse the association between adherence to guidelines for rational drug use and surrogate outcome markers for hypertension, diabetes and hypercholesterolaemia.


METHODS
The study used a cross-sectional ecological design. Data from dispensed prescriptions and medical records were analysed from 24 primary healthcare centres with a combined registered population of 330,000 patients in 2006. Guideline adherence was determined calculating the proportion of the prescribed volume of antidiabetic agents, antihypertensives and lipid-lowering agents representing the 14 different drugs included in the guidelines for these three areas. Patient outcome was assessed using surrogate marker data on HbA1C, blood pressure (BP) and s-cholesterol. The association between the guidelines adherence and outcomes measures was analysed by logistic regression.


RESULTS
The proportion of guideline antidiabetic drugs in relation to all antidiabetic drugs prescribed varied between 80% and 97% among the practices, the ratio of angiotensin converting enzyme (ACE)-inhibitors to all renin-angiotensin drugs 40-77% and the ratio of simvastatin to all statins 58-90%. The proportion of patients reaching targets for HbA1C, BP and s-cholesterol varied between 34% and 66%, 36% and 57% and 46% and 71% respectively. No significant associations were found between adherence to the guidelines and outcome. The expenditures for antihypertensives and lipid-lowering drugs could potentially be reduced by 10% and 50% respectively if all practices adhered to the guidelines as the top performing practices.


CONCLUSIONS
A substantial amount of money can be saved in primary care without compromising the quality of care by using recommended first-line drugs for the treatment diabetes, hypertension and hypercholesterolaemia.
Norman
C
C
Department of Drug Management and Informatics, Stockholm County Council, Stockholm, Sweden.
Zarrinkoub
R
R
Hasselström
J
J
Godman
B
B
Granath
F
F
Wettermark
B
B
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D000924:Anticholesteremic Agents / Q000191:economics* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000191:economics* / Q000627:therapeutic use; D017046:Cost Savings; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000191:economics*; D019983:Guideline Adherence; D005102:Health Expenditures; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use; D006937:Hypercholesterolemia / Q000188:drug therapy / Q000191:economics*; D006973:Hypertension / Q000188:drug therapy / Q000191:economics*; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics; D011787:Quality of Health Care; D019821:Simvastatin / Q000191:economics / Q000627:therapeutic use; D013548:Sweden
D000806:Angiotensin-Converting Enzyme Inhibitors; D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D019821:Simvastatin