Do herpes zoster patients receive antivirals? A Dutch national survey in general practice
Do herpes zoster patients receive antivirals? A Dutch national survey in general practice
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DOI：
10.1093/fampra/cmi055
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发表时间：
2005-10-01
期刊：
影响因子：
2.2
通讯作者：
Verheij, TJM
中科院分区：
文献类型：
--
作者：
Opstelten, W;van Essen, GA;Verheij, TJM
背景。带状疱疹（HZ）的主要并发症是带状疱疹后神经痛，在带状疱疹眼炎的情况下，眼睛疾病。抗病毒治疗可改变病程，减少并发症的发生。目的：探讨医生和患者的特点与hz抗病毒治疗处方的关系。荷兰的90家全科诊所（358008名患者）在数据库中登记了所有患者接触者，为期一年，作为第二次荷兰全国全科诊所调查的一部分。本研究使用ICPC代码S70在该数据库中搜索新诊断为HZ的患者。然后审查选定患者的全文医疗记录，并使用多水平逻辑回归模型分析抗病毒药物处方的潜在决定因素（包括患者、全科医生和实践的特征）。在1129例确诊为HZ的患者（发病率3.2/1000例/年）中，22.5%接受了抗病毒药物治疗。抗病毒治疗处方的独立决定因素是年龄[45-54岁：校正优势比（OR） 2.9 (95% CI 1.6-5.0)；55-64岁：OR 4.2 (95% CI 2.4-7.6)；65-74岁：OR 5.1 (95% CI 2.7-9.6)；>= 75岁：OR 8.1 (95% CI 4.4-15.1)]，带状疱疹的眼部定位（OR 3.2, 95% CI 1.6-6.7），以及哮喘/COPD的存在（OR 1.6, 95% CI 1.0-2.6）。报告强烈遵守专业指南的全科医生更频繁地开抗病毒药物（OR 1.9, 95% CI 1.2-3.1）。少数HZ患者接受抗病毒治疗。年龄增长、眼科定位、哮喘/慢性阻塞性肺病的存在以及对专业指南的遵守是支持处方的因素。关于全科医生治疗决定因素的更多信息对于成功实施HZ指南是必要的。
Background. The main complications of herpes zoster (HZ) are postherpetic neuralgia and, in case of HZ ophthalmicus, eye disorders. Antiviral treatment may modify the course of disease and reduce the risk of complications.Objective. To assess which doctors' and patients' characteristics were related to prescription of antiviral therapy for HZ.Methods. Ninety general practices (358 008 patients) in The Netherlands registered all patient contacts in a database for one year as part of the Second Dutch National Survey of General Practice. The present study used ICPC code S70 to search that database for patients with a new diagnosis of HZ. The full-text medical records of the selected patients were then reviewed and the potential determinants for the prescription of antiviral drugs (including characteristics of patients, GPs, and practices) analysed using multilevel logistic regression modelling.Results. Of the 1129 patients diagnosed with HZ (incidence 3.2/1000 patients/year), 22.5% received antiviral drugs. Independent determinants for prescription of antiviral therapy were age [45-54 years: adjusted odds ratio (OR) 2.9 (95% CI 1.6-5.0); 55-64 years: OR 4.2 (95% CI 2.4-7.6); 65-74 years: OR 5.1 (95% CI 2.7-9.6); >= 75 years: OR 8.1 (95% CI 4.4-15.1)], ophthalmic localisation of the shingles (OR 3.2, 95% CI 1.6-6.7), and the presence of asthma/COPD (OR 1.6, 95% CI 1.0-2.6). GPs who reported to strongly adhere to professional guidelines prescribe more frequently antiviral drugs (OR 1.9, 95% CI 1.2-3.1).Conclusions. A minority of HZ patients were prescribed antiviral treatment. Increasing age, ophthalmic localisation, presence of asthma/COPD, and adherence to professional guidelines were factors favouring prescription. More information on the determinants of GPs' treatment decisions is necessary for successful implementation of HZ guidelines.