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成人哮喘临床指南对吸入性皮质激素处方趋势的影响:一项准实验研究

2015/10/30

   摘要
   为了提高吸入性皮质激素(ICS)的使用以及减少住院治疗、急诊就诊数和哮喘最终的经济负担,制定了“2007年韩国成人哮喘管理指南”。为了评估指南对于内科医生开具哮喘ICS处方的影响,我们采用2003年到2010年门诊就诊患者的国家健康保险的索赔数据库,进行了分段回归和多重逻辑回归分析。我们把一年中的四分之一作为一个时间单位,并且比较指南推广前后的ICS处方。 总共观察了624,309 次哮喘的季度访问。 指南推广前后的 ICS处方率分别是13.3%和16.4% (P < 0.001)。在分段回归分析中,指南对整体的ICS处方率没有显著影响。在多重逻辑回归分析中, 指南对整体ICS处方影响不显著(优势比1.03; 95% CI, 1.00-1.06)。在亚组分析中, ICS处方在二级医院 (优势比1.15; 95% CI, 1.02-1.30) 以及综合性医院中有提高 (优势比1.10; 95% CI, 1.04-1.16)。然而,在覆盖81.7%哮喘病例的初级诊所中,没有显著变化(优势比 0.98; 95% CI, 0.94-1.02)。 从深入访谈中,我们可以确定,健康保险审查和评估服务的报销标准和患者对口服药物的偏爱是ICS处方的障碍。尤其是在初级诊所中,国内哮喘临床指南对ICS处方没有显著作用。

 


 

(杨冬 审校)
J Korean Med Sci. 2015 Aug;30(8):1048-54. doi: 10.3346/jkms.2015.30.8.1048. Epub 2015 Jul 15.



 

 

The Effect of Asthma Clinical Guideline for Adults on Inhaled Corticosteroids PrescriptionTrend: A Quasi-Experimental Study.
 

Kim SH1, Cho BL2, Shin DW3, Hwang SS4, Lee H3, Ahn EM3, Yun JM3, Chung YH3, Nam YS3.
 

Abstract
In order to increase inhaled corticosteroid (ICS) use and to reduce hospitalization, emergency department visits and ultimately the economic burden of asthma, "Korean Asthma Management Guideline for Adults 2007" was developed. To assess the guideline effects on physician's ICS prescription for asthma, we conducted segmented regression and multilevel logistic regression using National Health Insurance claims database of outpatient visits from 2003 to 2010. We set each quarter of a year as a time unit and compared ICS prescription between before and after guideline dissemination. A total of 624,309 quarterly visits for asthmawas observed. The ICS prescription rate before and after guideline dissemination was 13.3% and 16.4% respectively (P < 0.001). In the segmented regression, there was no significant guideline effect on overall ICS prescription rate. In multilevel logistic regression analyses, the effect of guideline on overall ICS prescription was not significant (odds ratio, 1.03; 95% CI, 1.00-1.06). In subgroup analysis, ICS prescription increased in secondary care hospitals (odds ratio, 1.15; 95% CI, 1.02-1.30) and in general hospitals (odds ratio, 1.10; 95% CI, 1.04-1.16). However, in primary clinics, which covered 81.7% of asthma cases, there was no significant change (odds ratio, 0.98; 95% CI, 0.94-1.02). From the in-depth interview, we could identify that the reimbursement criteria of the Health Insurance Review and Assessment Service and patient's preference for oral drug were barriers for the ICS prescription. The domestic asthma clinical guideline have no significant effect on ICS prescription, especially in primary clinics.

 

J Korean Med Sci. 2015 Aug;30(8):1048-54. doi: 10.3346/jkms.2015.30.8.1048. Epub 2015 Jul 15.


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下一篇: “检测和治疗”——对待维生素D缺乏和补充的态度:一项定性研究

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