Treatment Patterns with Antidementia Drugs in the United States: Medicare Cohort Study.
Treatment Patterns with Antidementia Drugs in the United States: Medicare Cohort Study.
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DOI：
10.1111/jgs.14226
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发表时间：
2016-08
影响因子：
6.3
通讯作者：
Bynum JP
中科院分区：
文献类型：
--
作者：
Koller D;Hua T;Bynum JP
目前，痴呆症没有治愈方法。两种抗痴呆药物被批准用于治疗症状，但获益程度很小，这引发了临床医生如何在使用它们时平衡风险和成本的问题。目的是评估使用频率、最有可能受益的人群是否得到治疗以及治疗开始的相关性。具有全国代表性的队列研究。按服务收费的医疗保险。 2009 年纳入 A、B 和 D 部分的 433,559 名老年痴呆症患者以及突发性痴呆亚组 (N=185,449)。主要结果是一年内任何抗痴呆药物胆碱酯酶抑制剂 [ChEI] 或美金刚）的处方配药。 55.8% 的痴呆患者和 49.3% 的痴呆患者接受了抗痴呆药物治疗。尽管美金刚不适用于轻度疾病，但 ChEI 和美金刚的使用之间没有差异（以第一年内死亡或生活在寄宿护理与社区环境中的死亡来衡量）。在事件病例中，住院护理的治疗开始率较低（RR：0.82，CI：0.81-0.83），并且合并症较多（RR：0.96，CI：0.96-0.96）。百分之六十的患者仅通过初级保健进行管理。相对于单独的初级保健，看神经病学或精神病学与较高的治疗可能性相关（RR：1.07，CI：1.06 -1.09；RR：1.17，CI：1.16 -1.19），而老年病学的治疗可能性较低，RR：0.96，CI：0.93-0.99）。在美国各地，不同医院转诊地区新诊断的患者开始接受抗痴呆治疗的比例从 32% 到 66% 不等（HRR）。临床细节不在索赔数据中，只能是近似值。晚期疾病患者较少使用抗痴呆药物，但药物选择并无差异。虽然初级保健提供者通常在没有专业支持的情况下开出抗痴呆药物，但专业之间的实践差异是显而易见的。
Currently, there is no curative treatment for dementia. Two anti-dementia drug classes are approved for treatment of symptoms but the magnitude of benefit is small, raising questions about how clinicians use them balanced against risks and cost. The objective is to evaluate frequency of use, whether populations most likely to benefit are treated, and correlates of treatment initiation. Nationally representative cohort study. Fee-for-service Medicare. 433,559 elderly patients with dementia, enrolled in Part A, B and D in 2009 and the subset with incident dementia (N=185,449). Main outcome is any prescription fill for anti-dementia drugs cholinesterase inhibitors [ChEI] or memantine) within one year. Treatment with anti-dementia drugs occurred in 55.8% of all dementia patients and 49.3% of incident dementia. There was no difference between ChEI and memantine use by dementia severity measured by death within first year or living in residential care vs. in a community setting) even though memantine is not indicated in mild disease. Among incident cases, initiation of treatment was lower in residential care (RR:0.82, CI:0.81-0.83) and with more comorbidities (RR:0.96, CI:0.96-0.96). Sixty percent of patients were managed by primary care alone. Seeing neurology or psychiatry was associated with higher likelihood of treatment (RR:1.07, CI:1.06 -1.09; RR:1.17, CI:1.16 -1.19) and geriatrics with lower RR:0.96, CI:0.93-0.99) relative to primary care alone. Across the United States, the proportion of newly diagnosed patients started on anti-dementia treatment varied from 32% to 66% across hospital referral regions HRR). Clinical details are not in claims data and can only be approximated. Anti-dementia drugs are less often used in people with late disease but there is not differentiation in medication choice. While primary care providers most often prescribe anti-dementia medication without specialty support, differences in practice between specialties are evident.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
39.2
作者：
Gill, Sudeep S.;Bronskill, Susan E.;Rochon, Paula A.
通讯作者：
Rochon, Paula A.
影响因子：
5.1
作者：
Hort, J.;O'Brien, J. T.;Scheltens, P.
通讯作者：
Scheltens, P.
影响因子：
4
作者：
Deudon, Audrey;Maubourguet, Nathalie;Robert, Philippe Henri
通讯作者：
Robert, Philippe Henri
DOI：
10.1016/0021-9681(87)90171-8
发表时间：
1987-01-01
期刊：
JOURNAL OF CHRONIC DISEASES
影响因子：
--
作者：
CHARLSON, ME;POMPEI, P;MACKENZIE, CR
通讯作者：
MACKENZIE, CR