哮喘联盟

   摘要
   背景：尽管有哮喘临床指南众多，患者仍常接受非最佳治疗方案。本研究根据国际心脏、肺部和血液协会（NHLBI）的哮喘诊断和治疗指南，在加拿大英属哥伦比亚地省的居民中确认非最佳治疗方案的哮喘患者，并评估其治疗方案与医疗保健服务使用情况之间的关系。
   方法：根据省医疗保健数据确认2009财年的共计65 345名哮喘患者（数据包括所有的呼吸系统疾病相关处方药配方，处方医生以及患者入院次数）。吸入短效支气管扩张剂（SABA）伴或不伴吸入皮质类固醇（ICS）分别定义为最佳方案和非最佳方案。在校正患者社会经济水平、住院史和既往哮喘急诊次数（ED）等因素后，采用Logistic回归模型分析治疗方案与医疗保健服务使用情况之间的关系。
   结果：采用非最佳治疗方案的患者使用医疗保健服务的风险显著高于采用最佳方案（SABA伴/或ICS）治疗的患者。相比其它年龄患者，接受非最佳治疗方案的青少年患者住院（OR3.8,95%CI 1.8-7.8），急诊（OR2.2,95%CI 1.6-3.1），以及家庭医生治疗（OR5.7,95%CI 4.0-8.1）的可能性均更高。
   结论：非最佳治疗方案导致患者需要医疗服务的风险显著增加。因此，根据哮喘临床指南识别正在接受非最佳治疗方案的患者，并改善其治疗方案将有可能降低患者的医疗服务使用。
 

(林江涛 审校)
Pharmacoepidemiol Drug Saf. 2013 Apr 5. doi: 10.1002/pds.3444. [Epub ahead of print]

 

High use of health services in patients with suboptimal asthma drug regimens: a population-based assessment in British Columbia, Canada.
 

Zhang T, Smith MA, Camp PG, Carleton BC.
 

Abstract
BACKGROUND: Despite numerous clinical guidelines on asthma management, patients often receive suboptimal drug therapy. This study identified patients who received suboptimal regimens according to the National Heart, Lung and Blood Institute (NHLBI) Guidelines for the Diagnosis and Management of Asthma in a complete population (residents of British Columbia, Canada) and determined the association between patients' regimens and utilization of healthcare services.
METHODS: A total of 65 345 asthma patients were identified using provincial health service utilization data (including all respiratory-related prescription medication dispensings, physician and hospital visits) for the 2009 fiscal year. Patient-specific regimens of inhaled short-acting bronchodilators (SABA) with or without inhaled corticosteroids (ICS) were categorized as optimal or suboptimal. Logistic regression models were used to determine the association between regimen optimality and health service utilization, adjusted for socioeconomic status, prior year hospital and emergency department (ED) visits for asthma.
RESULTS: Patients with suboptimal regimens had significantly greater risk of using health services than patients with optimal regimens of SABA and/or ICS. In particular, adolescents with suboptimal regimens were the most likely to have hospital admissions (odds ratio (OR) 3.8; 95% confidence interval (CI) 1.8-7.8), visit the ED (OR 2.2; 95% CI 1.6-3.1) and be high users of family physician services (OR 5.7; 95% CI 4.0-8.1) compared with patients in other age groups.
CONCLUSIONS: Suboptimal regimens are associated with significantly high usage of health services. Identifying patients with suboptimal regimens and improving their medication management in accordance with asthma clinical guidelines are likely to result in lower health service utilization.
 

Pharmacoepidemiol Drug Saf. 2013 Apr 5. doi: 10.1002/pds.3444. [Epub ahead of print]