Evidence-based prescribing of drugs for secondary prevention of acute coronary syndrome in Aboriginal and non-Aboriginal patients admitted to Western Australian hospitals

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Abstract

Aims: To assess the level of evidence-based drug prescribing for acute coronary syndrome (ACS) at discharge from Western Australian (WA) hospitals and determine predictors of such prescribing in Aboriginal and non-Aboriginal patients. Methods: All Aboriginal (2002-2004) and a random sample of non-Aboriginal (2003) hospital admissions with a principal diagnosis of ACS were extracted from the WA Hospital Morbidity Data Collection of WA Data Linkage System. Clinical information, history of co-morbidities and drugs were collected from medical notes by trained data collectors. Evidence-based prescribing (EBP) was defined as prescribing of aspirin, statin and beta-blocker or angiotensin-converting enzyme inhibitor/angiotensin II antagonist. Results: Records for 1717 ACS patients discharged alive from hospitals were reviewed. The majority of patients (71%) had EBP, and there was no significant difference between Aboriginal and non-Aboriginal patients (70% vs 71%, P = 0.36). Conversely, a significantly higher proportion of Aboriginal patients had none of the drugs prescribed compared with non-Aboriginal patients (11% vs 7%, P <0.01). EBP for ACS was independently associated with male sex (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.26-2.11), previous admission for ACS (OR 1.83, 95% CI 1.39-2.42) and diabetes (OR 1.36, 95% CI 1.04-1.79). However, ACS patients living in regional and remote areas, attending district or private hospitals, or with a history of chronic obstructive pulmonary disease were significantly less likely to have ACS drugs prescribed at discharge. Conclusions: Opportunity exists to improve prescribing of recommended drugs for ACS patients at discharge from WA hospitals in both Aboriginal and non-Aboriginal patients. Attention regarding pharmaceutical management post-ACS is particularly required for patients from rural and remote areas, and those attending district and private hospitals. © 2014 Royal Australasian College of Physicians.
Original languageEnglish
Pages (from-to)353-361
JournalInternal Medicine Journal
Volume44
Issue number4
Early online date23 Apr 2014
DOIs
Publication statusPublished - Apr 2014

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Drug Prescriptions
Acute Coronary Syndrome
Secondary Prevention
Private Hospitals
District Hospitals
Odds Ratio
Confidence Intervals
Pharmaceutical Preparations
Morbidity
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Patient Discharge
Information Storage and Retrieval
Sex Ratio
Angiotensin-Converting Enzyme Inhibitors
Information Systems
Angiotensin II
Chronic Obstructive Pulmonary Disease
Aspirin
Physicians

Cite this

@article{8135733196144b0ea1db1e60bce1e234,
title = "Evidence-based prescribing of drugs for secondary prevention of acute coronary syndrome in Aboriginal and non-Aboriginal patients admitted to Western Australian hospitals",
abstract = "Aims: To assess the level of evidence-based drug prescribing for acute coronary syndrome (ACS) at discharge from Western Australian (WA) hospitals and determine predictors of such prescribing in Aboriginal and non-Aboriginal patients. Methods: All Aboriginal (2002-2004) and a random sample of non-Aboriginal (2003) hospital admissions with a principal diagnosis of ACS were extracted from the WA Hospital Morbidity Data Collection of WA Data Linkage System. Clinical information, history of co-morbidities and drugs were collected from medical notes by trained data collectors. Evidence-based prescribing (EBP) was defined as prescribing of aspirin, statin and beta-blocker or angiotensin-converting enzyme inhibitor/angiotensin II antagonist. Results: Records for 1717 ACS patients discharged alive from hospitals were reviewed. The majority of patients (71{\%}) had EBP, and there was no significant difference between Aboriginal and non-Aboriginal patients (70{\%} vs 71{\%}, P = 0.36). Conversely, a significantly higher proportion of Aboriginal patients had none of the drugs prescribed compared with non-Aboriginal patients (11{\%} vs 7{\%}, P <0.01). EBP for ACS was independently associated with male sex (odds ratio (OR) 1.63, 95{\%} confidence interval (CI) 1.26-2.11), previous admission for ACS (OR 1.83, 95{\%} CI 1.39-2.42) and diabetes (OR 1.36, 95{\%} CI 1.04-1.79). However, ACS patients living in regional and remote areas, attending district or private hospitals, or with a history of chronic obstructive pulmonary disease were significantly less likely to have ACS drugs prescribed at discharge. Conclusions: Opportunity exists to improve prescribing of recommended drugs for ACS patients at discharge from WA hospitals in both Aboriginal and non-Aboriginal patients. Attention regarding pharmaceutical management post-ACS is particularly required for patients from rural and remote areas, and those attending district and private hospitals. {\circledC} 2014 Royal Australasian College of Physicians.",
author = "Kaniz Gausia and Judith Katzenellenbogen and Frank Sanfilippo and Matthew Knuiman and P.L. Thompson and Michael Hobbs and Sandra Thompson",
year = "2014",
month = "4",
doi = "10.1111/imj.12375",
language = "English",
volume = "44",
pages = "353--361",
journal = "Internal Medicine Journal (Print)",
issn = "1444-0903",
publisher = "John Wiley & Sons",
number = "4",

}

TY - JOUR

T1 - Evidence-based prescribing of drugs for secondary prevention of acute coronary syndrome in Aboriginal and non-Aboriginal patients admitted to Western Australian hospitals

AU - Gausia, Kaniz

AU - Katzenellenbogen, Judith

AU - Sanfilippo, Frank

AU - Knuiman, Matthew

AU - Thompson, P.L.

AU - Hobbs, Michael

AU - Thompson, Sandra

PY - 2014/4

Y1 - 2014/4

N2 - Aims: To assess the level of evidence-based drug prescribing for acute coronary syndrome (ACS) at discharge from Western Australian (WA) hospitals and determine predictors of such prescribing in Aboriginal and non-Aboriginal patients. Methods: All Aboriginal (2002-2004) and a random sample of non-Aboriginal (2003) hospital admissions with a principal diagnosis of ACS were extracted from the WA Hospital Morbidity Data Collection of WA Data Linkage System. Clinical information, history of co-morbidities and drugs were collected from medical notes by trained data collectors. Evidence-based prescribing (EBP) was defined as prescribing of aspirin, statin and beta-blocker or angiotensin-converting enzyme inhibitor/angiotensin II antagonist. Results: Records for 1717 ACS patients discharged alive from hospitals were reviewed. The majority of patients (71%) had EBP, and there was no significant difference between Aboriginal and non-Aboriginal patients (70% vs 71%, P = 0.36). Conversely, a significantly higher proportion of Aboriginal patients had none of the drugs prescribed compared with non-Aboriginal patients (11% vs 7%, P <0.01). EBP for ACS was independently associated with male sex (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.26-2.11), previous admission for ACS (OR 1.83, 95% CI 1.39-2.42) and diabetes (OR 1.36, 95% CI 1.04-1.79). However, ACS patients living in regional and remote areas, attending district or private hospitals, or with a history of chronic obstructive pulmonary disease were significantly less likely to have ACS drugs prescribed at discharge. Conclusions: Opportunity exists to improve prescribing of recommended drugs for ACS patients at discharge from WA hospitals in both Aboriginal and non-Aboriginal patients. Attention regarding pharmaceutical management post-ACS is particularly required for patients from rural and remote areas, and those attending district and private hospitals. © 2014 Royal Australasian College of Physicians.

AB - Aims: To assess the level of evidence-based drug prescribing for acute coronary syndrome (ACS) at discharge from Western Australian (WA) hospitals and determine predictors of such prescribing in Aboriginal and non-Aboriginal patients. Methods: All Aboriginal (2002-2004) and a random sample of non-Aboriginal (2003) hospital admissions with a principal diagnosis of ACS were extracted from the WA Hospital Morbidity Data Collection of WA Data Linkage System. Clinical information, history of co-morbidities and drugs were collected from medical notes by trained data collectors. Evidence-based prescribing (EBP) was defined as prescribing of aspirin, statin and beta-blocker or angiotensin-converting enzyme inhibitor/angiotensin II antagonist. Results: Records for 1717 ACS patients discharged alive from hospitals were reviewed. The majority of patients (71%) had EBP, and there was no significant difference between Aboriginal and non-Aboriginal patients (70% vs 71%, P = 0.36). Conversely, a significantly higher proportion of Aboriginal patients had none of the drugs prescribed compared with non-Aboriginal patients (11% vs 7%, P <0.01). EBP for ACS was independently associated with male sex (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.26-2.11), previous admission for ACS (OR 1.83, 95% CI 1.39-2.42) and diabetes (OR 1.36, 95% CI 1.04-1.79). However, ACS patients living in regional and remote areas, attending district or private hospitals, or with a history of chronic obstructive pulmonary disease were significantly less likely to have ACS drugs prescribed at discharge. Conclusions: Opportunity exists to improve prescribing of recommended drugs for ACS patients at discharge from WA hospitals in both Aboriginal and non-Aboriginal patients. Attention regarding pharmaceutical management post-ACS is particularly required for patients from rural and remote areas, and those attending district and private hospitals. © 2014 Royal Australasian College of Physicians.

U2 - 10.1111/imj.12375

DO - 10.1111/imj.12375

M3 - Article

VL - 44

SP - 353

EP - 361

JO - Internal Medicine Journal (Print)

JF - Internal Medicine Journal (Print)

SN - 1444-0903

IS - 4

ER -