Diversity of Participants in the 340B Drug Pricing Program for US Hospitals
Diversity of Participants in the 340B Drug Pricing Program for US Hospitals
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美国医院340B药品定价计划参与者的多样性
DOI：
10.1001/jamainternmed.2018.2015
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发表时间：
2018
影响因子：
39
通讯作者：
R. Conti
中科院分区：
文献类型：
--
作者：
S. Nikpay;Melinda Buntin;R. Conti
提高预防的总体比率，而不是总体适当性。尽管总体发生率有所改善，但非预期后果可能是低风险患者中VTE预防的过度管理。药物过度预防的主要缺点是大出血。5患者不适、福尔斯的潜在风险和机械预防的活动能力受损、药物费用和肝素诱导的血小板减少症风险是额外的问题。本研究的局限性包括其观察性设计存在固有偏倚。此外，该分析未纳入VTE事件，因此尚不清楚一种特定的VTE预防策略是否上级另一种。在对住院患者推广积极的VTE预防策略多年之后，重新努力缩减或“取消”低风险患者的这种做法可能是必要的。6然而，即使存在新的令人信服的数据，停止传统做法也很困难。
increasing overall rates of prophylaxis rather than overall appropriateness. Although overall rates have improved, the unintended consequence may be excess administration of VTE prophylaxis among low-risk patients. The major drawback to pharmacologic overprophylaxis is major bleeding.5 Patient discomfort, potential risk of falls and impaired mobility with mechanical prophylaxis, medication cost, and risk for heparin-induced thrombocytopenia are additional concerns. Limitations of this study include its observational design subject to inherent biases. Furthermore, this analysis did not incorporate VTE events, so it is unknown whether 1 specific VTE prophylaxis strategy was superior to another. After years of promoting aggressive VTE prophylaxis strategies for hospitalized patients, renewed effort to scale back—or “deimplement”—this practice in low-risk patients may be necessary.6 Discontinuing conventional practices, however, can be difficult, even in the presence of newer compelling data.