Appropriateness of Prescriptions of Recommended Treatments in Organisation for Economic Co-operation and Development Health Systems: Findings Based on the Long-Term Registry of the European Society of Cardiology on XXXX .

@entity1 @entity712 @entity339 @entity1030
OBJECTIVE: This observational study aimed to identify clinical variables and health system characteristics associated with incomplete guideline application in drug treatment of @entity1 with @entity712 (HF) across 15 countries. METHODS: Three data sets were used: European Society of Cardiology @entity712 Registry, Organisation for Economic Co-operation and Development's Health System Characteristics Survey, and Organisation for Economic Co-operation and Development Health Statistics 2013. @entity1 and country variables were examined by multilevel, multiple logistic regression. The study population consisted of ambulatory @entity1 with chronic HF and reduced ejection fraction. Inappropriateness of prescription of pharmacological treatments was defined as @entity1 not prescribed at least one of the two recommended treatments (angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers and beta-blockers) or treated with both medications but at suboptimal dosage and in absence of documented contraindication/intolerance. RESULTS: Of 4605 @entity1 , 1097 (23.8%) received inappropriate drug prescriptions with a large variation within and across countries, with 18.5% of the total variability accounted for by between-country health structure characteristics. @entity1 -level characteristics such as having @entity339 (odds ratio 1.4; 95% confidence interval 1.1-1.7) was significantly associated with inappropriate prescription of recommended drugs, whereas @entity1030 (odds ratio 0.7; 95% confidence interval 0.5-0.9) was associated with more appropriate prescriptions. Among the country-level variables, incentives or obligation to comply with guidelines increased the probability of prescription appropriateness. CONCLUSIONS: Combining clinical variables with health system characteristics is a promising exercise to explain the appropriateness of recommended drug prescriptions. Such an understanding can help decision makers to design more effective policies to improve adherence to guidelines, improve health care outcomes, and potentially reduce costs.
