Prescription Patterns of Lipid-Lowering Agents in the Community–Analysis of Primary Care Data

Background. The aim of the study was to determine the secondary preventive medical supply of patients with peripheral arterial disease (PAD) in German primary care.Methods and Results. A population-based case control study was conducted using electronic medical records of patients extracted from the CONTENT primary care database of Heidelberg, Germany, between April 2007 and March 2010. The prescription rates of cardiovascular medication among symptomatic PAD patients were analysed by means of the ATC classification and compared with those of patients with cardiovascular disease (CVD). 479 cases with PAD and 958 sex- and age-matched control CVD patients were identified. PAD patients showed significantly lower prescription rates for cardiac agents (21.7% versus 37%),β-blockers (50.1% versus. 66.2%), and lipid-lowering agents (50.3% versus 55.9%) compared to CVD patients. In contrast, significantly more prescriptions of antidiabetic agents (28.2% versus 20.3%), particularly insulin and analogues (12.5% versus 8%), and calcium channel blockers (29.2% versus 24.3%) were found in PAD patients. Low-dose aspirin use among both PAD and CVD patients was underestimated, as it is available without a prescription.Conclusions. Optimal pharmacotherapeutical care of patients with PAD requires more intensive cardioprotective medication in primary care settings.

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Assessment of Drug-Prescribing Problems in a Multidisciplinary Primary Care Clinic

Journal of Pharmacy Technology ◽

10.1177/875512259601200409 ◽

1996 ◽

Vol 12 (4) ◽

pp. 155-159 ◽

Cited By ~ 1

Author(s):

Jill E Otaguro ◽

Leann E Kruse

Keyword(s):

Primary Care ◽

Medical Center ◽

Primary Care Clinic ◽

Lipid Lowering ◽

Patient Specific ◽

Chronic Obstructive ◽

Care Clinic ◽

Drug Classes ◽

Problematic Drug ◽

Lipid Lowering Agents

Objective: To identify drug classes prone to prescribing problems in a multidisciplinary primary care clinic in a Department of Veterans Affairs Medical Center. Methods: Over a 10-week study period, the ambulatory care pharmacists reviewed the prescription profiles and medical records of every patient with an appointment in the Comprehensive Health Care Unit primary care clinic. Based on this review, the pharmacists made patient-specific consultations to the providers. They were also available during clinic hours for additional consultations and patient referrals. A standard data collection form was used to document all consultations. Results: The pharmacists made 1,701 consultations concerning 1,665 patients. The most problematic drug classes identified included anticoagulants, lipid-lowering agents, antiulcer agents, antihypertensive/ cardiovascular agents, chronic obstructive pulmonary disease/asthma agents, oral antidiabetic agents, nonsteroidal antiinflammatory drugs, and anticonvulsants. Anticoagulants and lipid-lowering agents were the most problematic drug classes, with most of the consultations related to dosing and monitoring requirements. Consultations had an 88.6% acceptance rate and resulted in a total monthly drug cost avoidance of $1,525. Conclusions: As a result of identifying the most problematic drug classes, computer programs have been developed to streamline the pharmacist review process, and clinical practice guidelines, posters, and educational handouts have been developed to promote appropriate prescribing.

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Benefits of Lipid-Lowering Agents Persists After Trials End

Clinical Endocrinology News ◽

10.1016/s1558-0164(11)70229-2 ◽

2011 ◽

Vol 6 (5) ◽

pp. 14

Author(s):

CAROLINE HELWICK

Keyword(s):

Lipid Lowering ◽

Lipid Lowering Agents

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CHARGE-AF in a national routine primary care electronic health records database in the Netherlands: validation for 5-year risk of atrial fibrillation and implications for patient selection in atrial fibrillation screening

Open Heart ◽

10.1136/openhrt-2020-001459 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001459

Author(s):

Jelle C L Himmelreich ◽

Wim A M Lucassen ◽

Ralf E Harskamp ◽

Claire Aussems ◽

Henk C P M van Weert ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

High Risk ◽

The Netherlands ◽

Patient Selection ◽

Low Cost ◽

Calibration Plot ◽

Primary Care Data ◽

C Statistic ◽

Kaplan Meier

AimsTo validate a multivariable risk prediction model (Cohorts for Heart and Aging Research in Genomic Epidemiology model for atrial fibrillation (CHARGE-AF)) for 5-year risk of atrial fibrillation (AF) in routinely collected primary care data and to assess CHARGE-AF’s potential for automated, low-cost selection of patients at high risk for AF based on routine primary care data.MethodsWe included patients aged ≥40 years, free of AF and with complete CHARGE-AF variables at baseline, 1 January 2014, in a representative, nationwide routine primary care database in the Netherlands (Nivel-PCD). We validated CHARGE-AF for 5-year observed AF incidence using the C-statistic for discrimination, and calibration plot and stratified Kaplan-Meier plot for calibration. We compared CHARGE-AF with other predictors and assessed implications of using different CHARGE-AF cut-offs to select high-risk patients.ResultsAmong 111 475 patients free of AF and with complete CHARGE-AF variables at baseline (17.2% of all patients aged ≥40 years and free of AF), mean age was 65.5 years, and 53% were female. Complete CHARGE-AF cases were older and had higher AF incidence and cardiovascular comorbidity rate than incomplete cases. There were 5264 (4.7%) new AF cases during 5-year follow-up among complete cases. CHARGE-AF’s C-statistic for new AF was 0.74 (95% CI 0.73 to 0.74). The calibration plot showed slight risk underestimation in low-risk deciles and overestimation of absolute AF risk in those with highest predicted risk. The Kaplan-Meier plot with categories <2.5%, 2.5%–5% and >5% predicted 5-year risk was highly accurate. CHARGE-AF outperformed CHA2DS2-VASc (Cardiac failure or dysfunction, Hypertension, Age >=75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [Female]) and age alone as predictors for AF. Dichotomisation at cut-offs of 2.5%, 5% and 10% baseline CHARGE-AF risk all showed merits for patient selection in AF screening efforts.ConclusionIn patients with complete baseline CHARGE-AF data through routine Dutch primary care, CHARGE-AF accurately assessed AF risk among older primary care patients, outperformed both CHA2DS2-VASc and age alone as predictors for AF and showed potential for automated, low-cost patient selection in AF screening.

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