Is the physician's adherence to prescription guidelines associated with the patient's socioeconomic position? - An analysis of statin prescription in South Sweden.

BACKGROUND: Knowledge about the social and economical determinants of prescription is relevant in health care systems like the Swedish one, which is based on the principle of equity, and which aims to allocate resources on the basis of need and not on criteria that are based on social constructs. We therefore investigated the association between patient and health care practice (HCP) characteristics on the one hand, and adherence to guidelines for statin prescription on the other, with a focus on social and economic conditions. METHODS: The study included all patients in the Skåne region of Sweden who received a statin prescription between July 2005 and December 2005; 15 581 patients in 139 privately-administered HCPs and 24 593 patients in 142 publicly-administered HCPs. Socioeconomic status was established using data from LOMAS (Longitudinal Multilevel Analysis in Skåne), and stratified multilevel regression analysis was performed. RESULTS: The proportion of patients receiving recommended statins was lower among privately-administered HCPs than among publicly-administered HCPs (65% vs. 80%). Among men (but not women), low income (PRprivateHCP = 1.04 (1.01-1.09) and PRpublicHCP = 1.02 (0.99-1.07)) and cohabitation (PRprivateHCP = 1.04 (1.04-1.08) and PRpublicHCP = 1.03 (1.01-1.07)) were associated with higher adherence to guidelines. CONCLUSION: The physician's decision to prescribe a recommended statin is conditioned by the socioeconomic and demographic characteristics of the patient. Beyond individual characteristics, the contextual circumstances of the HCP were also associated with adherence to guidelines. An increased understanding of the connection between the patient's socioeconomic status and the decisions made by the physician might be of relevance when planning interventions aimed at promoting efficient and evidence-based prescription