Open Access Open Badges Research article

Evaluating an implementation strategy in cardiovascular prevention to improve prescribing of statins in Germany: an intention to treat analysis

Heidemarie Keller1, Oliver Hirsch1*, Petra Kaufmann-Kolle2, Tanja Krones13, Annette Becker1, Andreas C Sönnichsen4, Erika Baum1 and Norbert Donner-Banzhoff1

Author Affiliations

1 Department of General Practice/Family Medicine, Philipps University of Marburg, Karl-von-Frisch-Strasse 4, Marburg, 35043, Germany

2 AQUA-Institute for Applied Quality Improvement and Research in Health Care, Göttingen, Germany

3 Clinical Ethics, University Hospital Zurich & Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland

4 Institute of General Practice, Family Medicine and Prevention, Paracelsus Medical University, Salzburg, Austria

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BMC Public Health 2013, 13:623  doi:10.1186/1471-2458-13-623

Published: 2 July 2013



The prescription of statins is an evidence-based treatment to reduce the risk of cardiovascular events in patients with elevated cardiovascular risk or with a cardiovascular disorder (CVD). In spite of this, many of these patients do not receive statins.


We evaluated the impact of a brief educational intervention in cardiovascular prevention in primary care physicians’ prescribing behaviour regarding statins beyond their participation in a randomised controlled trial (RCT). For this, prescribing data of all patients > 35 years who were counselled before and after the study period were analysed (each n > 75000). Outcome measure was prescription of Hydroxymethylglutaryl-CoA Reductase Inhibitors (statins) corresponding to patients’ overall risk for CVD. Appropriateness of prescribing was examined according to different risk groups based on the Anatomical Therapeutic Chemical Classification System (ATC codes).


There was no consistent association between group allocation and statin prescription controlling for risk status in each risk group before and after study participation. However, we found a change to more significant drug configurations predicting the prescription of statins in the intervention group, which can be regarded as a small intervention effect.


Our results suggest that an active implementation of a brief evidence-based educational intervention does not lead to prescription modifications in everyday practice. Physician’s prescribing behaviour is affected by an established health care system, which is not easy to change.

Trial registration


Evaluation studies; Intention to treat analysis; Cardiovascular diseases; Drug prescriptions; Hydroxymethylglutaryl-CoA Reductase Inhibitors