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Treatment Persistence and Variations in Prescribing Oral, Injectable, and Inhaled Corticosteroids: A Population-Based

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A small group of patients accounts for most corticosteroid (CS) prescribing. Identifying these high-prescribing individuals is key for safe and cost-effective CS use in primary care.

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Area of Science:

  • Pharmacology and Therapeutics
  • Primary Care Medicine
  • Health Services Research

Background:

  • Corticosteroids (CS) are widely prescribed in primary care.
  • Understanding prescribing patterns and treatment adherence is crucial for optimizing patient outcomes and resource allocation.
  • Variation in prescribing can lead to suboptimal treatment and increased costs.

Purpose of the Study:

  • To analyze the variation in prescribing patterns for oral, injectable, and inhaled corticosteroids (CS) within primary care settings.
  • To investigate treatment persistence and coverage among patients using different forms of CS.
  • To identify patient characteristics associated with higher CS prescribing doses.

Main Methods:

  • Utilized patient-level electronic health records from English general practices (Clinical Practice Research Datalink Aurum database).
  • Analyzed a cohort of new CS users from January 2000 to June 2021.
  • Employed Lorenz curves for prescribing skewness, Kaplan-Meier plots for treatment persistence, and the Proportion of Patients Covered (PPC) method for treatment coverage.

Main Results:

  • 20% of oral and inhaled CS users accounted for nearly 80% of total CS use.
  • Older patients with comorbidities (respiratory, skin, inflammatory bowel diseases) were more likely to receive higher CS doses.
  • Treatment persistence was 20% for oral CS and 50% for inhaled CS at 1 and 2 months, respectively; 6-month coverage was 30% for oral and 60% for inhaled CS.

Conclusions:

  • A significant prescribing skew exists, with a small proportion of patients driving the majority of oral and inhaled CS use in primary care.
  • Identifying patients with high CS prescribing is essential for targeted interventions.
  • Such interventions can enhance patient safety and promote cost-effective corticosteroid utilization.