Regional and temporal variation in the treatment of rheumatoid arthritis across the UK: a descriptive register-based cohort study.
Regional and temporal variation in the treatment of rheumatoid arthritis across the UK: a descriptive register-based cohort study.
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DOI：
10.1136/bmjopen-2012-001603
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发表时间：
2012
期刊：
影响因子：
2.9
通讯作者：
Arden NK
中科院分区：
文献类型：
--
作者：
Edwards CJ;Campbell J;van Staa T;Arden NK
描述目前在类风湿性关节炎（RA）中使用的改善病情的抗风湿药物（DMARDs）处方，并参考最佳实践，确定英国的时间和区域趋势。描述性、基于登记的队列研究。在1995年1月1日至2010年3月31日期间记录诊断为RA的≥18岁永久登记患者和匹配对照。通过筛选全科医学研究数据库（GPRD）中具有RA临床或转诊记录的所有患者以及至少1天的随访来确定RA参与者。 639英国的一般惯例向GPRD提供数据。按地区和时间段（1995-1999年、2000-2005年和2006- 2010年4月）列出的RA诊断后3 - 12个月的药物处方。在整个RA队列的35911例患者中，15259例患者（42%）发生了RA事件。 对RA患者的处方分析表明，1995年（基线）至2010年期间，DMARD（特别是甲氨蝶呤）在所有地区的处方中大幅增加，而联合DMARD处方的增加不太明显。以12个月处方为快照：DMARD处方在基线时为19-49%，到2006年至2010年4月增加到45-74%;甲氨蝶呤处方在基线时为4-16%，增加到32-60%;组合DMARD处方在基线时为0-8%，增加到3- 17%。然而，无论时间段如何，接受DMARD的RA患者比例存在明显的区域差异。自1995年以来，用于RA的DMARD处方大幅增加;然而，根据既定的最佳实践，英国各地的区域差异仍然存在，治疗相对不足。改善循证最佳临床实践的实施，以促进消除治疗差异是必要的。这可能是实施已发布的国家指南的结果。
To describe current disease-modifying antirheumatic drugs (DMARDs) prescription in rheumatoid arthritis (RA) with reference to best practice and to identify temporal and regional trends in the UK. Descriptive, register-based cohort study. Permanently registered patients aged ≥18 years with a recorded diagnosis of RA between 1 January 1995 and 31 March 2010 and matched controls. Participants with RA were identified through screening of all patients in the General Practice Research Database (GPRD) with a clinical or referral record for RA and at least 1 day of follow-up. 639 general practices in the UK supplying data to the GPRD. Medication prescribing between 3 and 12 months of RA diagnosis by region and time period (1995–1999, 2000–2005 and 2006–April 2010). Of the 35 911 patients in the full RA cohort, 15 259 patients (42%) had incident RA. Analysis of prescribing in incident RA patients demonstrated that between 1995 (baseline) and 2010 there was a substantial increase in DMARD, and specifically methotrexate, prescribing across all regions with a less marked increase in combination DMARD prescribing. Taking 12-month prescribing as a snapshot: DMARD prescribing was 19–49% at baseline increasing to 45–74% by 2006–April 2010; methotrexate prescribing was 4–16% at baseline increasing to 32–60%; combination DMARD prescribing was 0–8% at baseline increasing to 3–17%. However, there was marked regional variation in the proportion of RA patients receiving DMARD regardless of time period. There has been a substantial increase in prescribing of DMARDs for RA since 1995; however, regional variation persists across the UK with relative undertreatment, according to established best practice. Improved implementation of evidence-based best clinical practice to facilitate removal of treatment variation is warranted. This may occur as a result of the implementation of published national guidance.
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影响因子：
5.5
作者：
Edwards, CJ;Arden, NK;Cooper, C
通讯作者：
Cooper, C
影响因子：
27.4
作者：
Smolen JS;Landewé R;Breedveld FC;Dougados M;Emery P;Gaujoux-Viala C;Gorter S;Knevel R;Nam J;Schoels M;Aletaha D;Buch M;Gossec L;Huizinga T;Bijlsma JW;Burmester G;Combe B;Cutolo M;Gabay C;Gomez-Reino J;Kouloumas M;Kvien TK;Martin-Mola E;McInnes I;Pavelka K;van Riel P;Scholte M;Scott DL;Sokka T;Valesini G;van Vollenhoven R;Winthrop KL;Wong J;Zink A;van der Heijde D
通讯作者：
van der Heijde D
DOI：
10.1093/pubmed/21.3.299
发表时间：
1999-09-01
期刊：
JOURNAL OF PUBLIC HEALTH MEDICINE
影响因子：
--
作者：
Lawrenson, R;Williams, T;Farmer, R
通讯作者：
Farmer, R
影响因子：
--
作者：
Graudal, Niels;Jurgens, Gesche
通讯作者：
Jurgens, Gesche
影响因子：
3.4
作者：
Ovayolu, Nimet;Ovayolu, Ozlem;Karadag, Guelendam
通讯作者：
Karadag, Guelendam