Impact of ethnic-specific guidelines for anti-hypertensive prescribing in primary care in England: a longitudinal study.
Impact of ethnic-specific guidelines for anti-hypertensive prescribing in primary care in England: a longitudinal study.
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DOI：
10.1186/1472-6963-14-87
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发表时间：
2014-02-25
影响因子：
2.8
通讯作者：
Millett C
中科院分区：
文献类型：
--
作者：
Barrera L;Leaper C;Pape UJ;Majeed A;Blangiardo M;Millett C
在英国，国家健康与护理卓越研究所（NICE）制定了高血压管理指南。2006年，NICE指南引入了基于2004年英国高血压学会指南的种族年龄组算法，以指导抗高血压药物处方。对2007年在伦敦的旺兹沃斯登记的15933例18岁或以上的高血压患者进行了一项纵向回顾性研究，以评估抗高血压处方的变化。Logistic模型被用来衡量在此期间被规定的2006年NICE一线推荐的单药治疗NICE患者组之间的几率的变化。从2000年到2007年，推荐单药治疗的患者比例从54.2%增加到61.4%（年度趋势p < 0.0001）。在研究期间，黑人患者比年轻非黑人患者（OR 0.16，95% CI 0.12 - 0.21）和老年非黑人患者（OR 0.49，95% CI 0.37 - 0.65）更有可能接受推荐的单药治疗。引入NICE指南后，与潜在趋势相比，NICE推荐的单药治疗增加（OR 1.44，95% CI 1.19 - 1.75）。与黑人患者相比，在年轻非黑人患者中观察到推荐单药治疗的使用增加（OR 1.49，95% CI 1.17 - 1.91），但在老年非黑人患者中未观察到（OR 0.58，95% CI 0.46 - 0.74）。2006年NICE指南的引入对年轻非黑人患者的处方影响最大。黑人患者的相关增加较低可能是由于他们在基线时的推荐处方水平较高。分析表明，指南对所有患者群体的影响并不相同。
In England, the National Institute for Health and Care Excellence (NICE) produces guidelines for the management of hypertension. In 2006, the NICE guidelines introduced an ethnic-age group algorithm based on the 2004 British Hypertension Society guidelines to guide antihypertensive drug prescription. A longitudinal retrospective study with 15933 hypertensive patients aged 18 years or over and registered with 28 general practices in Wandsworth, London in 2007 was conducted to assess variations in antihypertensive prescribing. Logistic models were used to measure variations in the odds of being prescribed the 2006 NICE first line recommended monotherapy among NICE patient groups over the period. From 2000 to 2007, the percentage of patients prescribed the recommended monotherapy increased from 54.2% to 61.4% (p < 0.0001 for annual trend). Over the study period, black patients were more likely to be prescribed the recommended monotherapy than younger non-black patients (OR 0.16, 95% CI 0.12 – 0.21) and older non-black patients (OR 0.49, 95% CI 0.37 – 0.65). After the introduction of the NICE guidelines there was an increase in the NICE recommended monotherapy (OR 1.44, 95% CI 1.19 – 1.75) compared with the underlying trend. Compared to black patients, an increase in the use of recommended monotherapy was observed in younger non-black patients (OR 1.49, 95% CI 1.17 – 1.91) but not in older non-black patients (OR 0.58, 95% CI 0.46 – 0.74). The introduction of the 2006 NICE guideline had the greatest impact on prescribing for younger non-black patients. Lower associated increases among black patients may be due to their higher levels of recommended prescribing at baseline. The analysis suggests that guidelines did not impact equally on all patient groups.
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作者：
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通讯作者：
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作者：
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