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Adjustment for 'Prescriber Type' in Pharmacoepidemiological Analyses.

Saad Hanif Abbasi1, Jesper Hallas1, Peter Bjødstrup Jensen1

  • 1Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.

Basic & Clinical Pharmacology & Toxicology
|October 4, 2025
PubMed
Summary
This summary is machine-generated.

Adjusting for prescriber type in pharmacoepidemiological studies is valuable. This analysis of direct oral anticoagulants (DOACs) versus warfarin found prescriber type to be an effect modifier, impacting stroke risk findings.

Keywords:
confounder adjustmentconfoundingpharmacoepidemiologyprescriber settingprescriber type

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Area of Science:

  • Pharmacoepidemiology
  • Health Services Research
  • Biostatistics

Background:

  • Prescriber type is often a confounder in pharmacoepidemiological studies, influencing both treatment exposure and patient outcomes.
  • Healthcare registries frequently contain prescriber type data, yet it is underutilized in analyses.
  • Understanding prescriber influence is crucial for accurate drug safety assessments.

Purpose of the Study:

  • To investigate the value of adjusting for prescriber type in pharmacoepidemiological research.
  • To assess the impact of prescriber type on the association between direct oral anticoagulants (DOACs) and ischemic stroke risk.
  • To determine if prescriber type acts as an effect modifier in this association.

Main Methods:

  • A cohort study utilizing Danish healthcare registers.
  • Comparison of ischemic stroke risk between direct oral anticoagulants (DOACs) and warfarin.
  • Statistical adjustment for age, sex, and prescriber type; interaction testing and stratified analyses were performed.

Main Results:

  • Initial analysis (age, sex adjusted) showed a hazard ratio (HR) of 0.95 (95% CI: 0.90-1.01) for DOACs vs. warfarin.
  • Further adjustment for prescriber type yielded a similar HR of 0.92 (95% CI: 0.87-0.98).
  • Prescriber type was confirmed as a significant effect modifier through interaction testing and stratified analyses.

Conclusions:

  • Adjusting for prescriber type can refine pharmacoepidemiological findings.
  • Prescriber type significantly modifies the observed association between DOACs and ischemic stroke risk.
  • Further research is warranted to explore the role of prescriber type adjustment in diverse clinical settings.