Is the physician's adherence to prescription guidelines associated with the patient's socio-economic position? An analysis of statin prescription in South Sweden.
BACKGROUND
Knowledge about the social and economical determinants of prescription is relevant in healthcare systems like the Swedish one, which is based on the principle of equity, and which aims to allocate resources on the basis of need and not on criteria that are based on social constructs. We therefore investigated the association between patient and healthcare practice (HCP) characteristics on the one hand, and adherence to guidelines for statin prescription on the other, with a focus on social and economic conditions.


METHODS
The study included all patients in the Skåne region of Sweden who received a statin prescription between July 2005 and December 2005; 15 581 patients in 139 privately administered HCPs and 24 593 patients in 142 publicly administered HCPs. Socio-economic status was established using data from Longitudinal Multilevel Analysis in Skåne, and a stratified multilevel regression analysis was performed.


RESULTS
The proportion of patients receiving recommended statins was lower among privately administered HCPs than among publicly administered HCPs (65% vs 80%). Among men (but not women), low income (PR(privateHCP)=1.04 (1.01 to 1.09) and PR(publicHCP)=1.02 (0.99 to 1.07)) and cohabitation (PR(privateHCP)=1.04 (1.04 to 1.08) and PR(publicHCP)=1.03 (1.01 to 1.07)) were associated with a higher adherence to guidelines.


CONCLUSIONS
The physician's decision to prescribe a recommended statin is conditioned by the socio-economic and demographic characteristics of the patient. Beyond individual characteristics, the contextual circumstances of the HCP were also associated with adherence to guidelines. An increased understanding of the connection between the patient's socio-economic status and the decisions made by the physician might be of relevance when planning interventions aimed at promoting efficient and evidence-based prescription.
Ohlsson
Henrik
H
Malmö University Hospital, Malmö, Sweden. henrik.ohlsson@med.lu.se
Lynch
Kristian
K
Merlo
Juan
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012923:Social Class; D013548:Sweden; D055815:Young Adult
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors