Wide regional variation in the prescribing of medication to prevent heart disease in the Republic is leading to treatment inequalities, according to research published in the current edition of the Irish Medical Journal.
Dr Kathleen Bennett and colleagues at the National Medicines Information Centre and the Department of Pharmacology and Therapeutics, St James's Hospital, Dublin, examined prescription data from the General Medical Services (GMS) scheme for 12 months between September 1999 and August 2000.
The 42,275 medical card patients received cardiac medication from their GPs and the researchers assessed the level of prescribing for other drugs which are recommended to protect against further heart attack and stroke.
The analysis revealed a twofold regional variation in the prescribing of ACE inhibitors (a drug used in the treatment of high blood pressure and heart failure) and a 1.6 times difference in statin prescribing.
Statins can reduce the incidence of heart attack and stroke by at least a third in patients with a history of heart disease, stroke and diabetes.
While there was no consistent pattern to the regional variation, generally the level of prescribing of preventive therapies was worst in the Western Health Board Area. The least regional variability was observed for the use of aspirin, where the authors note "the evidence for its effectiveness in ischaemic heart disease is more established and the consensus almost unanimous".
The analysis also showed prescribing inequalities based on gender and age.
Female patients with established heart disease were less likely than males to receive aspirin, beta-blockers and ACE inhibitors.
Younger patients were more likely to receive aspirin, statins and beta-blockers, while elderly patients did better when ACE inhibitor prescribing was analysed.
Noting that this was the first published study to look at regional variations in prescribing, Dr Bennett said: "Despite the aspirations of the National Health Strategy, it shows a wide variation in the prescribing of preventative therapies for ischaemic heart disease."
The health strategy, published last November states: "Patients should not be restricted in their access to a service because of income or ability to pay or because of their place of residence, gender or age."
Asked about the implications of the research, Prof Andrew Murphy, professor of general practice at NUI Galway, said the regional variations were hard to explain and difficult to interpret.
He noted that while GMS prescribing covered 70 per cent of total prescribing in the State, there was a need for a computerised database of primary care to allow for a full analysis of both public and private prescribing.
Emphasising the need for the consideration of socio-economic status in future research into prescribing patterns, Prof Murphy said: "The variations in care in the study highlight the urgency in delivering the agreed cardiac secondary preventative programme in general practice.
"This has been agreed between the Irish College of General Practitioners, the health boards and the Department of Health. It will deliver a structured package of care to patients with established heart disease and is due for delivery in October this year."