title: Appropriateness of Prescriptions of Recommended Treatments in Organisation for Economic Co-operation and Development Health Systems: Findings Based on the Long-Term Registry of the European Society of Cardiology on Heart Failure.
abstract: OBJECTIVE
  This observational study aimed to identify clinical variables and health system characteristics associated with incomplete guideline application in drug treatment of patients with chronic heart failure (HF) across 15 countries.
  
  
  METHODS
  Three data sets were used: European Society of Cardiology Heart Failure Registry, Organisation for Economic Co-operation and Development's Health System Characteristics Survey, and Organisation for Economic Co-operation and Development Health Statistics 2013. Patient and country variables were examined by multilevel, multiple logistic regression. The study population consisted of ambulatory patients with chronic HF and reduced ejection fraction. Inappropriateness of prescription of pharmacological treatments was defined as patients not prescribed at least one of the two recommended treatments (angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers and beta-blockers) or treated with both medications but at suboptimal dosage and in absence of documented contraindication/intolerance.
  
  
  RESULTS
  Of 4605 patients, 1097 (23.8%) received inappropriate drug prescriptions with a large variation within and across countries, with 18.5% of the total variability accounted for by between-country health structure characteristics. Patient-level characteristics such as having mitral regurgitation (odds ratio 1.4; 95% confidence interval 1.1-1.7) was significantly associated with inappropriate prescription of recommended drugs, whereas chronic obstructive pulmonary disease (odds ratio 0.7; 95% confidence interval 0.5-0.9) was associated with more appropriate prescriptions. Among the country-level variables, incentives or obligation to comply with guidelines increased the probability of prescription appropriateness.
  
  
  CONCLUSIONS
  Combining clinical variables with health system characteristics is a promising exercise to explain the appropriateness of recommended drug prescriptions. Such an understanding can help decision makers to design more effective policies to improve adherence to guidelines, improve health care outcomes, and potentially reduce costs.
authors.affiliation: ANMCO Research Center, Florence, Italy; EORP Department, European Society of Cardiology, Sophia Antipolis, France. Electronic address: centrostudi@anmco.it.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: OECD, Directorate for Employment, Labour and Social Affairs, Health Division, Paris, France; Centre for Health Economics Research and Evaluation, University of Technology, Sydney, Australia.
authors.forename: Kees
authors.initials: K
authors.lastname: Van Gool
authors.affiliation: OECD, Directorate for Employment, Labour and Social Affairs, Health Division, Paris, France.
authors.forename: Nelly
authors.initials: N
authors.lastname: Biondi
authors.affiliation: ANMCO Research Center, Florence, Italy; Department of Medicine, Surgery and Neuroscience, Pharmacology Unit "G. Segre," University of Siena, Siena, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Urso
authors.affiliation: OECD, Directorate for Employment, Labour and Social Affairs, Health Division, Paris, France; Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Niek
authors.initials: N
authors.lastname: Klazinga
authors.affiliation: Azienda Ospedaliero-Universitaria di Ferrara, Ospedale di Cona, Cona (FE), Italy; Maria Cecilia Hospital - GVM Care & Research - E.S. Health Science Foundation, Cotignola, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.affiliation: Health Services Organisation & Management, National School of Public Health, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Maniadakis
authors.affiliation: Maria Cecilia Hospital - GVM Care & Research - E.S. Health Science Foundation, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D004363:Drug Utilization; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D066150:Organisation for Economic Co-Operation and Development / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D011787:Quality of Health Care; D012042:Registries; D013318:Stroke Volume
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents
keywords: guidelines; health systems; heart failure