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Is the physician's adherence to prescription guidelines associated with the patient's socio-economic position? An analysis of statin prescription in South Sweden
  1. Henrik Ohlsson1,2,
  2. Kristian Lynch1,
  3. Juan Merlo1,2
  1. 1Social Epidemiology, Department of Clinical Science, Faculty of Medicine, Lund University, Lund, Sweden
  2. 2Division of Social Medicine, Skåne County, Sweden
  1. Correspondence to Mr Henrik Ohlsson, Social Epidemiology, CRC, Malmö University Hospital, 205 02 Malmö, Sweden; henrik.ohlsson{at}


Background Knowledge about the social and economical determinants of prescription is relevant in healthcare systems like the Swedish one, which is based on the principle of equity, and which aims to allocate resources on the basis of need and not on criteria that are based on social constructs. We therefore investigated the association between patient and healthcare practice (HCP) characteristics on the one hand, and adherence to guidelines for statin prescription on the other, with a focus on social and economic conditions.

Methods The study included all patients in the Skåne region of Sweden who received a statin prescription between July 2005 and December 2005; 15 581 patients in 139 privately administered HCPs and 24 593 patients in 142 publicly administered HCPs. Socio-economic status was established using data from Longitudinal Multilevel Analysis in Skåne, and a stratified multilevel regression analysis was performed.

Results The proportion of patients receiving recommended statins was lower among privately administered HCPs than among publicly administered HCPs (65% vs 80%). Among men (but not women), low income (PRprivateHCP=1.04 (1.01 to 1.09) and PRpublicHCP=1.02 (0.99 to 1.07)) and cohabitation (PRprivateHCP=1.04 (1.04 to 1.08) and PRpublicHCP=1.03 (1.01 to 1.07)) were associated with a higher adherence to guidelines.

Conclusion The physician's decision to prescribe a recommended statin is conditioned by the socio-economic and demographic characteristics of the patient. Beyond individual characteristics, the contextual circumstances of the HCP were also associated with adherence to guidelines. An increased understanding of the connection between the patient's socio-economic status and the decisions made by the physician might be of relevance when planning interventions aimed at promoting efficient and evidence-based prescription.

  • Guideline adherence
  • socio-economic position
  • decision-making
  • equity
  • multilevel methods
  • prescribing
  • social epidemiology

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  • Funding This study was supported by grants from the Scania Region's Health Care Research Funds and the Swedish Research Council (VR) (Juan Merlo; # 2004-6155). The Centre for Economical Demography at the Lund University (December 2008), and the Swedish Scientific Council (# 2004-6155).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the the Regional Ethical Review Board in Lund.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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