Physician variation in the de‐adoption of ineffective statin and fibrate therapy. (10th February 2021)

• Record Type: Journal Article
• Authors: Everhart, Alexander; Desai, Nihar R.; Dowd, Bryan; Herrin, Jeph; Higuera, Lucas; Jeffery, Molly Moore; Jena, Anupam B.; Ross, Joseph S.; Shah, Nilay D.; Smith, Laura Barrie; Karaca‐Mandic, Pinar
• Is Part Of: Health services research. Volume 56:Number 5(2021)
• Page Start: 919
• Page End: 931
• Publication Date: 2021-02-10
• Subjects: diabetes mellitus -- fibric acids -- hydroxymethylglutaryl‐CoA reductase inhibitors -- longitudinal studies -- physicians -- Type 2; Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.13630
• Languages: English
• ISSNs: 0017-9124

Abstract

Abstract: Objective: To describe physicians' variation in de‐adopting concurrent statin and fibrate therapy for type 2 diabetic patients following a reversal in clinical evidence. Data Sources: We analyzed 2007‐2015 claims data from OptumLabs ® Data Warehouse, a longitudinal, real‐world data asset with de‐identified administrative claims and electronic health record data. Study Design: We modeled fibrate use among Medicare Advantage and commercially insured type 2 diabetic statin users before and after the publication of the ACCORD lipid trial, which found statins and fibrates were no more effective than statins alone in reducing cardiovascular events among type 2 diabetic patients. We modeled fibrate use trends with physician random effects and physician characteristics such as age and specialty. Data Extraction: We identified patient‐year‐quarters with one year of continuous insurance enrollment, type 2 diabetes diagnoses, and fibrate use. We designated the physician most responsible for patients' diabetes care based on evaluation and management visits and prescriptions of glucose‐lowering drugs. Principal Findings: Fibrate use increased by 0.12 percentage points per quarter among commercial patients (95% CI, 0.10 to 0.14) and 0.17 percentage points per quarter among Medicare Advantage patients (95% CI, 0.13 to 0.20) before the trial and then decreased by 0.16 percentage points per quarter among commercial patients (95% CI, −0.18 to −0.15) and 0.05 percentage points per quarter among Medicare Advantage patients (95% CI, −0.06 to −0.03) after the trial. However, 45% of physicians treating commercial patients and 48% of physicians treating Medicare Advantage patients had positive trends in prescribing following the trial. Physicians' characteristics did not explain their variation (pseudo R 2 = 0.000). Conclusion: On average, physicians decreased fibrate prescribing following the ACCORD lipid trial. However, many physicians increased prescribing following the trial. Observable physician characteristics did not explain variations in prescribing. Future research should examine whether physicians vary similarly in other de‐adoption settings.