title: Time series evaluation of an intervention to increase statin tablet splitting by general practitioners.
abstract: BACKGROUND
  Tablet splitting, in which a higher-dose tablet is split to get 2 doses, reduces patients' drug costs. Statins can be split safely. General practitioners (GPs) may not direct their patients to split statins because of safety concerns or unawareness of costs. Medical chart inserts provide cost-effective education to physicians.
  
  
  OBJECTIVE
  The aim of this study was to assess whether providing GPs with statin-splitting chart inserts would increase splitting rates, and to identify predictors of splitting.
  
  
  METHODS
  In 2005 and 2006, we faxed a statin chart insert to British Columbia GPs with a request for a telephone interview. Consenting GPs were mailed 3 statin chart inserts and interviewed by phone (the intervention). In an interrupted time series, we compared monthly rates of statin-splitting prescriptions among intervention and nonintervention GPs before, during, and after the intervention. In multivariate logistic regressions accounting for patient clustering, predictors of splitting included physician and patient demographics and the specific statin prescribed.
  
  
  RESULTS
  Of 5051 GPs reached, 282 (6%) agreed to the intervention. Before the intervention, GPs' splitting rate was 2.6%; after intervention, GPs' splitting rate was 7.5%. The rate for the nonintervention GPs was 4.4%. Intervention GPs were 1.68 (95% CI, 1.12-2.53) times more likely to prescribe splitting after the intervention than were nonintervention GPs. Other predictors were a patient's female sex (odds ratio [OR] = 1.26; 95% CI, 1.18-1.34), lower patient income (OR = 1.33; 95% CI, 1.18-1.34), and a lack of drug insurance (OR = 1.89; 95% CI, 1.69-2.04).
  
  
  CONCLUSIONS
  An inexpensive intervention was effective in producing a sustained increase in GPs' splitting rate during 22 months of observed follow-up. Expanding statin-splitting education to all GPs might reduce prescription costs for many patients and payors.
authors.affiliation: Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Boston, Massachusetts 02120, USA. jpolinski@partners.org
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Polinski
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schneeweiss
authors.forename: Malcolm
authors.initials: M
authors.lastname: Maclure
authors.forename: Blair
authors.initials: B
authors.lastname: Marshall
authors.forename: Samuel
authors.initials: S
authors.lastname: Ramsden
authors.forename: Colin
authors.initials: C
authors.lastname: Dormuth
mesh_terms: D001955:British Columbia; D017046:Cost Savings / Q000191:economics*; D016527:Drug Costs; D011307:Drug Prescriptions; D058005:General Practitioners; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000191:economics*; D007356:Insurance, Pharmaceutical Services; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D013607:Tablets
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D013607:Tablets