Biological and steroid use in relationship to quality measures in older patients with inflammatory bowel disease: a US Medicare cohort study.
Biological and steroid use in relationship to quality measures in older patients with inflammatory bowel disease: a US Medicare cohort study.
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DOI：
10.1136/bmjopen-2015-008597
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发表时间：
2015-09-07
期刊：
影响因子：
2.9
通讯作者：
Smith MA
中科院分区：
文献类型：
--
作者：
Johnson SL;Bartels CM;Palta M;Thorpe CT;Weiss JM;Smith MA
研究抗肿瘤坏死因子(TNF)的使用频率和预测因素，并描述65岁及以上的美国炎症性肠病(IBD)患者中类固醇的使用情况，此前发布了一项新的联邦医疗保险质量指标，呼吁使用抗肿瘤坏死因子和其他非类固醇药物。回顾性队列研究。这项研究利用了2006-2009年的全国医疗保险受益人样本的索赔数据。没有抗肿瘤坏死因子禁忌症的炎症性肠病患者(1个ICD代码555.xx，556.xx)，参加A和B部分≥12 月和D部分≥6 月的患者(n=8502)。我们使用多变量泊松回归估计了预测新的抗肿瘤坏死因子治疗的发生率比(IRR)和95%的顺应值。这项对老年IBD患者进行的具有全国代表性的研究估计，只有3.7%的患者接受了抗肿瘤坏死因子治疗。新的抗肿瘤坏死因子使用(1.4%)与年龄较小、没有医疗补助覆盖、住院以及以前使用Burst(IRR=2.35，CI 1.59至3.47)和较高的维持性类固醇(IRR=2.40，CI 1.05至5.48)有关。在抗肿瘤坏死因子使用者中，我们观察到同时使用维持性类固醇的比率很高(19%)。在这群患有IBD的老年患者中，抗肿瘤坏死因子的使用率非常低，重要的是，尽管指南建议减少需求，但抗肿瘤坏死因子的使用经常与维持性类固醇的使用相结合。将针对IBD的质量措施扩大到包括类固醇缩减计划可能会提示适当的维持方案，其中包括抗肿瘤坏死因子和其他类固醇节约剂，同时减少当前质量措施所希望的长期伴随的类固醇使用。
To examine the frequency and predictors of antitumour necrosis factor (TNF) use, and to describe steroid utilisation among US patients with inflammatory bowel disease (IBD) aged 65 years and older prior to the publication of a new Medicare quality measure calling for the use of anti-TNFs and other steroid-sparing agents. Retrospective cohort study. This study utilised 2006–2009 claims data for a national sample of Medicare beneficiaries. Patients with IBD (>1 claim for ICD codes 555.xx, 556.xx) without anti-TNF contraindications, enrolled in Medicare parts A and B ≥12 months and part D ≥6 months were included (n=8502). We estimated incidence rate ratios (IRR) and 95% CIs predicting new anti-TNF therapy using multivariable Poisson regression. This nationally representative study of older patients with IBD estimated that only 3.7% received anti-TNFs. New anti-TNF use (1.4%) was associated with younger age, absence of Medicaid coverage, hospitalisation, and higher preceding use of burst (IRR=2.35, CI 1.59 to 3.47) and maintenance steroids (IRR=2.40, CI 1.05 to 5.48). Among anti-TNF users, we observed high rates of concurrent maintenance steroid use (19%). Anti-TNF use was very low in this population of older patients with IBD and, importantly, was often combined with maintenance steroid use despite guidelines suggesting reduced needs. Expanding IBD-specific quality measures to include steroid taper plans may cue appropriate maintenance regimens that include anti-TNFs and other steroid sparing agents while reducing protracted concomitant steroid use as intended by current quality measures.