GPs should be given incentives to prescribe statins for primary prevention through QOF, primary care academics said after finding marked variation in prescribing of the drugs for this indication.
The researchers said they found particularly low rates of statin prescribing in socially disadvantaged groups, which they said supported the introduction of QOF incentives to prescribe them for primary prevention and recent NICE advice to extend use of statins to millions more people at low risk.
But GP leaders told Pulse they would resist any further use of QOF to oblige GPs to prescribe the drugs to more healthy people.
Earlier in the year, GPs rejected NICE’s plan to lower the 10-year risk threshold for primary CVD prevention from 20% to 10% and make millions more people eligible for a statin.
However, NICE pushed through the recommendation, leading to concerns it could soon be introduced into QOF. Currently QOF incentivises GPs to prescribe statins to newly diagnosed hypertensive patients with a 10-year CVD risk of 20% or more – via the CVD-P0001 indicator.
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The researchers looked at over 6,000 GP practices in England for the year 2006 to 2007, and used statistical modelling to estimate the proportion of eligible patients that were given statins from primary or secondary cardiovascular disease (CVD) prevention.
They estimated that 10.5% of the population as a whole were dispensed a statin for any indication, while 6.3% received a statin for primary CVD prevention.
But the team said prescribing rates varied widely, with evidence that older people, those from ethnic minorities and the socially deprived were much less likely to be prescribed statins for primary prevention.
In a small minority of practices, statin prescribing was so low they would not have covered the predicted proportion of their population who had already had a stroke or coronary event.
Writing in the journal BMC Health Services Research, they concluded: ‘Absolute estimated prescribing rates for primary prevention of CVD were 6.3% of the population. There was evidence of social inequalities in statin prescribing for primary prevention. These findings support the recent introduction of a financial incentive for primary prevention of CVD in England.’
But Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said the BMA would not support any further use of QOF to increase statin prescribing.
Dr Green said: ‘Statins undoubtedly have a role in primary prevention of cardiovascular disease, the challenge is to ensure that those who stand to benefit most are treated. It is always interesting to look at reasons for variation between practices, but we would not support any extension of QOF into this area.’
He added: ‘We do get involved in discussions about NICE indicators and QOF, and this year as usual the two negotiating parties will consider all NICE recommendations as part of our discussions, and then agree a set of proposals as part of any wider contractual change. Remember that last year we declined all NICE recommendations for new indicators.’
BMC Health Services Research 2014; available online 20 September
