Clinical Decisionmaking

Overprescribing of lipid-lowering agents is associated with several physician and practice characteristics

Overprescribing of statins and other lipid-lowering agents to patients with high levels of cholesterol is commonplace, and it has increased in recent years, according to a new study. Researchers surveyed 2,034 physicians in 1996-1997 (baseline) and again in 1998-1999. The survey asked physicians if they would recommend an oral lipid-lowering agent for 50-year-old men who had a total cholesterol of 240, low-density lipoprotein (LDL) of 150, and high-density lipoprotein (HDL) of 50 after 6 months on a low-cholesterol diet. The men had no other cardiac risk factors.

These are patients for whom the National Cholesterol Education Program (NCEP) guidelines do not recommend lipid-lowering agents. Nevertheless, 39 percent of physicians recommended lipid-lowering agents to these theoretical patients at baseline, which increased to 51 percent at followup. Doctors who were more likely to overprescribe these medications at baseline were half as likely to be board certified, and were nearly twice as likely to be in solo or two-physician practices or to be family physicians.

Physicians with large increases in overprescribing during the study period were more likely than those with small increases to be international medical graduates and to spend more hours in patient care. Organizational incentives had little association with overprescribing. Publication of research studies about the benefits of stricter LDL control and direct-to-consumer advertising of statins may have led some physicians to prescribe beyond guideline recommendations. Efforts to raise awareness of cardiovascular health and the importance of cholesterol screening could also have sparked more prescribing, suggest the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS13183).

More details are in "Overprescribing of lipid lowering agents," by Maureen A. Smith, M.D., M.P.H., Ph.D., Elizabeth D. Cox, M.D., M.P.H., and Jessica M. Bartell, in the October 10, 2006, Quality & Safety in Health Care 15, pp. 251-257.

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