Determinants of selective cyclooxygenase-2 inhibitor prescribing: Are patient or physician characteristics more important?
Determinants of selective cyclooxygenase-2 inhibitor prescribing: Are patient or physician characteristics more important?
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DOI：
10.1016/j.amjmed.2003.08.025
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发表时间：
2003-12-15
影响因子：
5.9
通讯作者：
Avorn, J
中科院分区：
文献类型：
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作者：
Solomon, DH;Schneeweiss, S;Avorn, J
背景：对于哪些因素影响选择性环氧合酶(COX)-2抑制剂的广泛使用，我们知之甚少。我们检查了患者胃肠道毒性危险因素、其他患者特征和医生处方偏好对处方选择性COX-2抑制剂的相对影响。方法：我们回顾性研究了一组28,190名医疗保险受益人，他们连续参加了一个大型的国有药房福利计划，该计划报销选择性COX-2抑制剂和非选择性非甾体抗炎药（NSAIDs），没有限制。一半的研究样本服用选择性COX-2抑制剂，另一半服用非选择性非甾体抗炎药。建立了多变量logistic回归模型来预测COX-2抑制剂的使用。结果：17%使用COX-2抑制剂的患者没有可识别的NSAID相关胃肠道毒性危险因素，而使用非选择性NSAID的患者为23%。已确定的危险因素（年龄大于或等于75岁，胃肠道出血或消化性溃疡病史，或合并使用华法林或口服糖皮质激素）都是COX-2抑制剂使用的显著预测因素，但仅包括这些危险因素的多变量模型在两组患者之间的区别较差（C统计量= 0.55）。在模型中加入其他患者的临床和人口学特征，在一定程度上改善了这种关联（C统计量= 0.66）；然而，当纳入医生处方偏好时，该模型在两个治疗组之间具有出色的区分能力（C统计量= 0.83）。结论：nsaid相关胃肠道毒性的既定危险因素不能很好地预测谁开了选择性COX-2抑制剂；相比之下，医生的处方偏好是一个重要的决定因素(C) 2003年由摘录医药公司。
BACKGROUND: Little is known about which factors influence the widespread use of selective cyclooxygenase (COX)-2 inhibitors. We examined the relative effects of patient risk factors for gastrointestinal toxicity, other patient characteristics, and physician prescribing preferences on the decision to prescribe a selective COX-2 inhibitor.METHODS: We retrospectively studied a cohort of 28,190 Medicare beneficiaries who were continuously enrolled in a large, state-run pharmacy benefits program that reimbursed for selective COX-2 inhibitors and nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) without restrictions. Half of the study sample filled a prescription for a selective COX-2 inhibitor and the other half for a nonselective NSAID. Multivariable logistic regress ion models were developed to predict COX-2 inhibitor use.RESULTS: Seventeen percent of patients using a COX-2 inhibitor had no identifiable risk factor for NSAID-associated gastro-intestinal toxicity, compared with 23% of those using a nonselective NSAID. Established risk factors (age greater than or equal to75 years, history of gastrointestinal hemorrhage or peptic ulcer disease, or concomitant warfarin or oral glucocorticoid use) were all significant predictors of COX-2 inhibitor use, but a multivariable model including only these risks factors discriminated poorly between the two patient groups (C statistic = 0.55). Adding other patient clinical and demographic characteristics to the model somewhat improved this association (C statistic = 0.66); however, when physician prescribing preference was included, the model had excellent ability to discriminate between the two treatment groups (C statistic = 0.83).CONCLUSION: Established risk factors for NSAID-associated gastrointestinal toxicity were poor predictors of who was prescribed a selective COX-2 inhibitor; in contrast, physician prescribing preference was an important determinant (C) 2003 by Excerpta Medica Inc.