Estimating the influence of physicians on the underuse of drugs in diabetic nephropathy in Taiwan.
BACKGROUND
Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) are widely recommended to hinder the progression of renal disease among patients with DM. However, little is known about adherence to these guidelines or the predictors of such use.


METHODS
Data from the Taiwan National Health Insurance was used to investigate 7,186 DN patients, nested within 2960 randomly assigned primary care physicians in Taiwan over the course of 1 year of treatment. Patient-level variables included gender, age, and co-morbidity (i.e., coronary arterial disease, congestive heart failure, cerebrovascular disease, peripheral arterial disease, DM complications, albuminuria, anemia, hyperlipidemia, asthma, gout, and depression). Physician-level variables included work experience, the area of specialization, and the level of the physicians working in the hospital.


RESULTS
We determined that 63.69% of the variation in the use of ACEIs or ARBs was at the within-physician level and 36.31% was at the between-physician level. Approximately 35.10 % of the total variation was explained by predictors related to patient characteristics. The likelihood of taking ACEIs or ARBs is significantly higher (12.92%) among male patients than females. Cardiologists and family doctors are more likely to prescribe ACEIs or ARBs in of doctors working in medical centers.


CONCLUSIONS
Management of DN patients is less than optimal due to unfamiliarity on the part of physicians regarding treatment guidelines and a lack of awareness among the general population with regard to DN. Educational initiatives are required to ensure adherence to clinical practice guidelines in the evaluation and care of DN patients.
Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan.
Li-Ying
LY
Huang
Hseng-Long
HL
Yeh
Syi
S
Su
Ting-Chung
TC
Wang
Jun Yi
JY
Hsieh
D000368:Aged; D000704:Analysis of Variance; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care / Q000193:education / Q000592:standards; D017410:Practice Guidelines as Topic; D013624:Taiwan; D016903:Drug Monitoring
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents