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OBJECTIVES: To compare the determinants of initial statin prescribing between New Zealand and Australia. New Zealand has a system-wide absolute risk-based approach to primary care cardiovascular disease (CVD) management, while Australia has multiple guidelines. METHOD: Classification and Regression Tree (CART) analysis of two observational studies of primary care CVD management from New Zealand (PREDICT-CVD) and Australia (AusHeart). Over 80% of eligible New Zealanders have been screened for CVD risk. PREDICT-CVD is used by approximately one-third of New Zealand GPs to perform web-based CVD risk assessment in routine practice, with the sample consisting of 126,519 individuals risk assessed between 1 January 2007 and 30 June 2014. AusHeart is a cluster-stratified survey of primary care CVD management that enrolled 534 GPs from across Australia, who in turn recruited 1381 patients between 1 April and 30 June 2008. Eligibility was restricted to 55-74year old patients without prior CVD. RESULTS: The CART analyses demonstrated that New Zealand GPs prescribe statins primarily on the basis of absolute risk, while their Australian counterparts are influenced by a variety of individual risk factors, including total cholesterol, LDL cholesterol and diabetes. CONCLUSIONS: Countries seeking to improve their management of CVD should consider adopting a 'whole of system' absolute risk-based approach with clear guidelines that are consistent with drug reimbursement rules; and include computerized decision-support tools that aid decision-making and allow monitoring of outcomes and continual improvement of practice.

Original publication

DOI

10.1016/j.healthpol.2017.09.022

Type

Journal

Health Policy

Publication Date

12/2017

Volume

121

Pages

1233 - 1239

Keywords

CART, Cardiovascular disease, Funding of health care, Prescribing, Aged, Australia, Cardiovascular Diseases, Cholesterol, Female, General Practitioners, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Male, Middle Aged, New Zealand, Practice Patterns, Physicians', Primary Health Care, Risk Assessment, Risk Factors, Triglycerides