Objective: To describe physicians’ variation in de-adopting concurrent statin and fibrate therapy for type 2 diabetic patients following a reversal in clinical evidence. Data Sources: We analyzed 2007-2015 claims data from OptumLabs® Data Warehouse, a longitudinal, real-world data asset with de-identified administrative claims and electronic health record data. Study Design: We modeled fibrate use among Medicare Advantage and commercially insured type 2 diabetic statin users before and after the publication of the ACCORD lipid trial, which found statins and fibrates were no more effective than statins alone in reducing cardiovascular events among type 2 diabetic patients. We modeled fibrate use trends with physician random effects and physician characteristics such as age and specialty. Data Extraction: We identified patient-year-quarters with one year of continuous insurance enrollment, type 2 diabetes diagnoses, and fibrate use. We designated the physician most responsible for patients’ diabetes care based on evaluation and management visits and prescriptions of glucose-lowering drugs. Principal Findings: Fibrate use increased by 0.12 percentage points per quarter among commercial patients (95% CI, 0.10 to 0.14) and 0.17 percentage points per quarter among Medicare Advantage patients (95% CI, 0.13 to 0.20) before the trial and then decreased by 0.16 percentage points per quarter among commercial patients (95% CI, −0.18 to −0.15) and 0.05 percentage points per quarter among Medicare Advantage patients (95% CI, −0.06 to −0.03) after the trial. However, 45% of physicians treating commercial patients and 48% of physicians treating Medicare Advantage patients had positive trends in prescribing following the trial. Physicians’ characteristics did not explain their variation (pseudo R2 = 0.000). Conclusion: On average, physicians decreased fibrate prescribing following the ACCORD lipid trial. However, many physicians increased prescribing following the trial. Observable physician characteristics did not explain variations in prescribing. Future research should examine whether physicians vary similarly in other de-adoption settings.
Bibliographical noteFunding Information:
Joint Acknowledgment/Disclosure Statement: Analyses were supported by funding from the National Institute on Aging (P01 AG005842), the National Heart, Lung, and Blood Institute (R56 HL130496), and the Agency for Healthcare Research and Quality (R01 HS025164). Alexander Everhart and Laura Barrie Smith also acknowledge support from the AHRQ doctoral training program at the University of Minnesota (T32 HS000036) during the conduct of this study.
© 2021 Health Research and Educational Trust
- Type 2
- diabetes mellitus
- fibric acids
- hydroxymethylglutaryl-CoA reductase inhibitors
- longitudinal studies
PubMed: MeSH publication types
- Journal Article
- Research Support, N.I.H., Extramural