DOI: 10.1101/19008748Oct 18, 2019Paper

Trends and variation in prescribing of suboptimal statin treatment regimes: a cohort study in English primary care

MedRxiv : the Preprint Server for Health Sciences
Helen J CurtisBen Goldacre


Objectives: We set out to describe trends and variation in statin prescribing in England that breaches 2014 national guidance on "high-intensity" statins. We identify factors associated with breaching; and assess the feasibility of rapid prescribing behaviour change. Design, Setting and Participants: Retrospective cohort study in NHS primary care in England, including all 8,142 standard general practices from August 2010 to March 2019. Main Outcome Measures: We categorised statins as high or low/medium-intensity based on two different thresholds, and calculated the proportion prescribed below these thresholds across all practices. We plotted trends and geographical variation, carried out mixed effects logistic regression to identify practice characteristics associated with breaching guidance, and used indicator saturation to identify practices exhibiting sudden changes in prescribing. Results: We included all 8,142 practices across the study period. The proportion of statin prescriptions below the recommended 40% LDL-lowering threshold decreased gradually since 2012 from 80% to 45%; the proportion below a pragmatic 37% threshold decreased from 30% to 18%. The 2014 guidance had minimal impact on these trends. We found wide varia...Continue Reading

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