Dual renin-angiotensin-aldosterone blockade: Implementation of published research and Dear Doctor letters in ambulatory care: A retrospective observational study using prescription data.

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Abstrakt

Tytuł:: Dual renin-angiotensin-aldosterone blockade: Implementation of published research and Dear Doctor letters in ambulatory care: A retrospective observational study using prescription data.
Autorzy:: Angelow A; Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
Ploner T; InGef-Institute for Applied Health Research Berlin GmbH, Berlin, Germany.
Grimmsmann T; Health Insurance Medical Service (MDK) Mecklenburg-Vorpommern, Schwerin, Germany.
Walker J; InGef-Institute for Applied Health Research Berlin GmbH, Berlin, Germany.
Chenot JF; Department of General Practice, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.
Źródło:: Pharmacoepidemiology and drug safety [Pharmacoepidemiol Drug Saf] 2020 May; Vol. 29 (5), pp. 530-537. Date of Electronic Publication: 2020 Mar 11.
Typ publikacji:: Journal Article; Observational Study
Język:: English
Imprint Name(s):: Original Publication: Chichester, West Sussex : Wiley, 1992-
MeSH Terms:: Ambulatory Care*
Insurance Claim Review*
Practice Patterns, Physicians'*
Angiotensin Receptor Antagonists/*therapeutic use
Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
Angiotensin Receptor Antagonists/administration & dosage ; Angiotensin-Converting Enzyme Inhibitors/administration & dosage ; Cohort Studies ; Drug Therapy, Combination ; Female ; Germany ; Humans ; Male ; Middle Aged ; Retrospective Studies
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Contributed Indexing:: Keywords: ACE inhibitors; ARB; Dear Doctor letter; dual RAS blockade; pharmacoepidemiology
Substance Nomenclature:: 0 (Angiotensin Receptor Antagonists)
0 (Angiotensin-Converting Enzyme Inhibitors)
Entry Date(s):: Date Created: 20200313 Date Completed: 20210408 Latest Revision: 20210408
Update Code:: 20240105
DOI:: 10.1002/pds.4965
PMID:: 32162407
: Czasopismo naukowe

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Purpose: This study aims to assess the implementation of published research, contraindications, and warnings on the prescription of dual renin-angiotensin-hormone system (RAS) blockade in ambulatory care in Germany.
Methods: Cohort study based on health claims data of 6.7 million subjects from 2008 to 2015. Yearly prevalence and incidence for dual RAS blockade with (a) angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (ACEI + ARB) and (b) aliskiren and ACEI or ARB (aliskiren + ACEI/ARB) were calculated. We assessed prescriber specialty and associations between discontinuing dual RAS blockade with specialist (internal medicine, cardiology, nephrology) visits and hospital discharge in the previous year.
Results: A total of 2 984 517 patients were included (age 51.4 ± SD 18.4 y, 48.5% male). Prescription rates for ACEI + ARB decreased from 0.6% (n = 17 907) to 0.4% (n = 12 237) and for aliskiren + ACEI/ARB from 0.23% (n = 6634) to 0.03% (n = 818). Incident prescriptions decreased from 0.23% (n = 6705) to 0.19% (n = 5055) (ACE + ARB) and from 0.1% (n = 2796) to 0.005% (n = 142) (aliskiren + ACE/ARB); 59% of ACEI + ARB and 48% of aliskiren + ACE/ARB combinations were prescribed only by one physician. Of those, 73% (ACEI + ARB) and 58% (aliskiren + ACE/ARB) were primary care providers (PCPs). Discontinuing dual RAS blockade was associated with specialist care and hospital discharge in the previous year (specialist care: RR 1.4, 95% CI, 1.3-1.6; hospital visit: RR 1.5, 95% CI, 1.3-1.6).
Conclusions: Our results suggest a delayed uptake of treatment recommendation for ACEI + ARB and a higher impact of Dear Doctor letters addressing PCPs directly compared with published research, contraindications, and warnings. Targeted continuous medical education, practice software alerts, and stronger involvement of pharmacists might improve the implementation of medication safety recommendations in ambulatory care.
(© 2020 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons Ltd.)

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