Underprescribing of cardiovascular therapies for diabetes in primary care

Kenneth Arthur Bennett, David Williams, J. Feely

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Objective: To determine the extent to which cardiovascular therapies are prescribed in primary care for those with diabetes, compared with those without diabetes.

Methods: Population study of patients with and without diabetes identified using a national primary care prescribing database. All patients receiving a prescription for any diabetes therapy., including insulin and oral bypoglycaemic drugs, or diagnostic test kit for glucose (n = 8523) and those receiving no such therapies (n = 145,756) during a 1-year period (September 1999-August 2000) in the Eastern Regional Health Authority of Ireland were identified. In addition, a sub-set of patients receiving a nitrate prescription, a marker for ischaemic heart disease (IHD), were also identified (n = 14,826). Odds ratios and 95% confidence intervals for prescribing of cardiovascular therapies between those with diabetes and those without, adjusted for age and ender, were calculated using logistic regression.

Results: The proportion of those (and 95% CES) with diabetes and IHD prescribed secondary preventative therapies was 37.3% (35.0, 39.6) for statins, 55.3% (53.0, 57.6) for angiotension converting enzyme inhibitors, 34.7% (32.5, 36.9) for beta blockers, 73.3% (71.2, 75.4) for aspirin, 4.4% (3.4, 5.4) for angiotensin-II antagonists and 2.5% (1.8, 3.2) for fibrates. The adjusted odds ratios for prescribing in those with diabetes compared with those without are 1.44 (1.30, 1.61) for statins, 3.09 (2.79, 3.42) for angiotension converting enzyme inhibitors, 0.82 (0.74, 0.91) for beta blockers, 1.23 (1.09, 1.38) for aspirin, 1.47 (1.13, 1.87) for angiotensin-II receptor blockers and 4.23 (2.88, 6.14) for lipid-lowering fibrates.

Conclusion: The greater rate of prescribing of cardiovascular therapies in those with diabetes relative to those without is not unexpected given the higher risk of coronary heart disease in those with diabetes. However, the proportion of patients with diabetes, particularly those with established IHD, prescribed cardiovascular therapies is considerably below that recommended in local and international guidelines.

Original languageEnglish
Pages (from-to)835-841
Number of pages6
JournalEuropean Journal of Clinical Pharmacology
Volume58
Issue number12
DOIs
Publication statusPublished - 2003

Keywords

  • secondary preventative therapies
  • prescription databases
  • primary care
  • CORONARY HEART-DISEASE
  • MYOCARDIAL-INFARCTION
  • RANDOMIZED TRIAL
  • GENERAL-PRACTICE
  • RISK FACTOR
  • MORTALITY
  • MEN
  • HYPERTENSION
  • INTERVENTION
  • PREVENTION

Cite this

Underprescribing of cardiovascular therapies for diabetes in primary care. / Bennett, Kenneth Arthur; Williams, David; Feely, J.

In: European Journal of Clinical Pharmacology, Vol. 58, No. 12, 2003, p. 835-841.

Research output: Contribution to journalArticle

Bennett, Kenneth Arthur ; Williams, David ; Feely, J. / Underprescribing of cardiovascular therapies for diabetes in primary care. In: European Journal of Clinical Pharmacology. 2003 ; Vol. 58, No. 12. pp. 835-841.
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abstract = "Objective: To determine the extent to which cardiovascular therapies are prescribed in primary care for those with diabetes, compared with those without diabetes.Methods: Population study of patients with and without diabetes identified using a national primary care prescribing database. All patients receiving a prescription for any diabetes therapy., including insulin and oral bypoglycaemic drugs, or diagnostic test kit for glucose (n = 8523) and those receiving no such therapies (n = 145,756) during a 1-year period (September 1999-August 2000) in the Eastern Regional Health Authority of Ireland were identified. In addition, a sub-set of patients receiving a nitrate prescription, a marker for ischaemic heart disease (IHD), were also identified (n = 14,826). Odds ratios and 95{\%} confidence intervals for prescribing of cardiovascular therapies between those with diabetes and those without, adjusted for age and ender, were calculated using logistic regression.Results: The proportion of those (and 95{\%} CES) with diabetes and IHD prescribed secondary preventative therapies was 37.3{\%} (35.0, 39.6) for statins, 55.3{\%} (53.0, 57.6) for angiotension converting enzyme inhibitors, 34.7{\%} (32.5, 36.9) for beta blockers, 73.3{\%} (71.2, 75.4) for aspirin, 4.4{\%} (3.4, 5.4) for angiotensin-II antagonists and 2.5{\%} (1.8, 3.2) for fibrates. The adjusted odds ratios for prescribing in those with diabetes compared with those without are 1.44 (1.30, 1.61) for statins, 3.09 (2.79, 3.42) for angiotension converting enzyme inhibitors, 0.82 (0.74, 0.91) for beta blockers, 1.23 (1.09, 1.38) for aspirin, 1.47 (1.13, 1.87) for angiotensin-II receptor blockers and 4.23 (2.88, 6.14) for lipid-lowering fibrates.Conclusion: The greater rate of prescribing of cardiovascular therapies in those with diabetes relative to those without is not unexpected given the higher risk of coronary heart disease in those with diabetes. However, the proportion of patients with diabetes, particularly those with established IHD, prescribed cardiovascular therapies is considerably below that recommended in local and international guidelines.",
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T1 - Underprescribing of cardiovascular therapies for diabetes in primary care

AU - Bennett, Kenneth Arthur

AU - Williams, David

AU - Feely, J.

PY - 2003

Y1 - 2003

N2 - Objective: To determine the extent to which cardiovascular therapies are prescribed in primary care for those with diabetes, compared with those without diabetes.Methods: Population study of patients with and without diabetes identified using a national primary care prescribing database. All patients receiving a prescription for any diabetes therapy., including insulin and oral bypoglycaemic drugs, or diagnostic test kit for glucose (n = 8523) and those receiving no such therapies (n = 145,756) during a 1-year period (September 1999-August 2000) in the Eastern Regional Health Authority of Ireland were identified. In addition, a sub-set of patients receiving a nitrate prescription, a marker for ischaemic heart disease (IHD), were also identified (n = 14,826). Odds ratios and 95% confidence intervals for prescribing of cardiovascular therapies between those with diabetes and those without, adjusted for age and ender, were calculated using logistic regression.Results: The proportion of those (and 95% CES) with diabetes and IHD prescribed secondary preventative therapies was 37.3% (35.0, 39.6) for statins, 55.3% (53.0, 57.6) for angiotension converting enzyme inhibitors, 34.7% (32.5, 36.9) for beta blockers, 73.3% (71.2, 75.4) for aspirin, 4.4% (3.4, 5.4) for angiotensin-II antagonists and 2.5% (1.8, 3.2) for fibrates. The adjusted odds ratios for prescribing in those with diabetes compared with those without are 1.44 (1.30, 1.61) for statins, 3.09 (2.79, 3.42) for angiotension converting enzyme inhibitors, 0.82 (0.74, 0.91) for beta blockers, 1.23 (1.09, 1.38) for aspirin, 1.47 (1.13, 1.87) for angiotensin-II receptor blockers and 4.23 (2.88, 6.14) for lipid-lowering fibrates.Conclusion: The greater rate of prescribing of cardiovascular therapies in those with diabetes relative to those without is not unexpected given the higher risk of coronary heart disease in those with diabetes. However, the proportion of patients with diabetes, particularly those with established IHD, prescribed cardiovascular therapies is considerably below that recommended in local and international guidelines.

AB - Objective: To determine the extent to which cardiovascular therapies are prescribed in primary care for those with diabetes, compared with those without diabetes.Methods: Population study of patients with and without diabetes identified using a national primary care prescribing database. All patients receiving a prescription for any diabetes therapy., including insulin and oral bypoglycaemic drugs, or diagnostic test kit for glucose (n = 8523) and those receiving no such therapies (n = 145,756) during a 1-year period (September 1999-August 2000) in the Eastern Regional Health Authority of Ireland were identified. In addition, a sub-set of patients receiving a nitrate prescription, a marker for ischaemic heart disease (IHD), were also identified (n = 14,826). Odds ratios and 95% confidence intervals for prescribing of cardiovascular therapies between those with diabetes and those without, adjusted for age and ender, were calculated using logistic regression.Results: The proportion of those (and 95% CES) with diabetes and IHD prescribed secondary preventative therapies was 37.3% (35.0, 39.6) for statins, 55.3% (53.0, 57.6) for angiotension converting enzyme inhibitors, 34.7% (32.5, 36.9) for beta blockers, 73.3% (71.2, 75.4) for aspirin, 4.4% (3.4, 5.4) for angiotensin-II antagonists and 2.5% (1.8, 3.2) for fibrates. The adjusted odds ratios for prescribing in those with diabetes compared with those without are 1.44 (1.30, 1.61) for statins, 3.09 (2.79, 3.42) for angiotension converting enzyme inhibitors, 0.82 (0.74, 0.91) for beta blockers, 1.23 (1.09, 1.38) for aspirin, 1.47 (1.13, 1.87) for angiotensin-II receptor blockers and 4.23 (2.88, 6.14) for lipid-lowering fibrates.Conclusion: The greater rate of prescribing of cardiovascular therapies in those with diabetes relative to those without is not unexpected given the higher risk of coronary heart disease in those with diabetes. However, the proportion of patients with diabetes, particularly those with established IHD, prescribed cardiovascular therapies is considerably below that recommended in local and international guidelines.

KW - secondary preventative therapies

KW - prescription databases

KW - primary care

KW - CORONARY HEART-DISEASE

KW - MYOCARDIAL-INFARCTION

KW - RANDOMIZED TRIAL

KW - GENERAL-PRACTICE

KW - RISK FACTOR

KW - MORTALITY

KW - MEN

KW - HYPERTENSION

KW - INTERVENTION

KW - PREVENTION

U2 - 10.1007/s00228-002-0542-6

DO - 10.1007/s00228-002-0542-6

M3 - Article

VL - 58

SP - 835

EP - 841

JO - European Journal of Clinical Pharmacology

JF - European Journal of Clinical Pharmacology

SN - 0031-6970

IS - 12

ER -