Survey of antiobesity drug prescribing for obese children and young people in UK primary care.
Survey of antiobesity drug prescribing for obese children and young people in UK primary care.
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英国初级保健中肥胖儿童和青少年抗肥胖药物处方的调查。
DOI：
10.1136/bmjpo-2017-000104
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发表时间：
2017
影响因子：
2.6
通讯作者：
Wong ICK
中科院分区：
文献类型：
--
作者：
White B;Hsia Y;Kinra S;Saxena S;Christie D;Viner RM;Wong ICK
初级保健中为儿童和青少年 (CYP) 开出的抗肥胖药物 (AOD) 正在增加，且停药率很高。关于该群体的处方情况，包括患者人口统计数据和合并症、开始和停止的原因或遵守国家指南的情况，人们知之甚少。使用覆盖英国 6% 人口的全国代表性初级保健数据库对全科医生 (GP) 进行问卷调查。英国范围内的初级保健。 2010年至2012年间，如果患者开具AOD处方，年龄≤18岁，则符合资格。通过国家处方数据库，共识别了来自108个独特诊所的151名患者，其中来自84个诊所的119名患者（79%）有反应； 119 名中的 94 名 (79%) 有资格入选。全科医生对 CYP 服用 AOD 处方习惯的调查。我们根据国家健康与护理卓越研究所 (NICE) 指南审核了奥利司他的使用情况。 47% 的患者服用二甲双胍，59% 的患者服用奥利司他，5% 的患者服用两种药物。奥利司他主要由全科医生独立开处方（49/55 处方，89%），二甲双胍则由全科医生根据专家推荐开处方（12/44，27%）。奥利司他主要用于 16 岁以上无身体合并症的患者。二甲双胍最初用于治疗多囊卵巢综合征（70%）、胰岛素抵抗（25%）和血糖控制受损（9%）。二甲双胍的中位供应量为 10.5 个月（IQR 4–18.5 个月），奥利司他的中位供应量为 2.0 个月（1.0–4.0）（p≤0.001）。药物终止主要是由于家庭不要求重复处方。 NICE 指南的遵守率较低； 17% 的奥利司他处方是由专家开出的，56% 的处方有肥胖相关合并症的证据。与成人相比，全科医生报告将 AOD 改为 CYP 处方的信心较低（10 分 Likert 评分中位数为 3 比 8，p<0.001）。由于对 NICE 指南的遵守率较低，初级保健中 AOD 处方具有挑战性。需要进一步的工作来更好地支持 GP 在 CYP 中使用 AOD。
Antiobesity drug (AOD) prescribing in children and young people (CYP) in primary care is rising with high rates of discontinuation. Little is known about prescribing in this group in terms of patient demographics and comorbidities, reasons for initiation and discontinuation, or adherence to national guidelines. Questionnaire survey to general practitioners (GPs) identified using a nationally representative primary care database covering 6% of UK population. UK-wide primary care. Patients were eligible if prescribed an AOD aged ≤18 years between 2010 and 2012. A total of 151 patients from 108 unique practices were identified via national prescribing database, with responses for 119 patients (79%) from 84 practices; 94 of 119 (79%) were eligible for inclusion. Survey of GP prescribing habits of AODs to CYP. We audited orlistat usage against the National Institute for Health and Care Excellence (NICE) guidance. 47% were prescribed metformin, 59% orlistat and 5% both drugs. Orlistat was largely prescribed by GPs independently (49/55 prescriptions, 89%) and metformin by GPs on specialist recommendation (12/44, 27%). Orlistat was largely prescribed in those over 16 years of age without physical comorbidities. Metformin was initiated for treatment of polycystic ovarian syndrome (70%), insulin resistance (25%) and impaired glucose control (9%). Median supply of metformin was 10.5 months (IQR 4–18.5 months) and 2.0 months (1.0–4.0) for orlistat (p≤0.001). Drug terminations were largely due to families not requesting repeat prescriptions. NICE guidance adherence was low; 17% of orlistat prescriptions were initiated by specialists, and 56% had evidence of obesity-related comorbidity. GPs reported lower confidence in prescribing AOD to CYP compared with adults (10-point Likert score median 3 vs 8, p<0.001). Prescribing of AOD in primary care is challenging with low adherence to NICE guidance. Further work is needed to better support GPs in the use of AOD in CYP.
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影响因子：
16.2
作者：
Park MH;Kinra S;Ward KJ;White B;Viner RM
通讯作者：
Viner RM
影响因子：
2.6
作者：
Kelley, K;Clark, B;Sitzia, J
通讯作者：
Sitzia, J
影响因子：
3.4
作者：
Viner, Russell M.;Hsia, Yingfen;Wong, Ian C. K.
通讯作者：
Wong, Ian C. K.
影响因子：
8.9
作者：
Viner, R. M.;Hsia, Y.;Wong, I. C. K.
通讯作者：
Wong, I. C. K.
DOI：
10.1136/archdischild-2011-301127
发表时间：
2013-06-01
影响因子：
1
作者：
Petkar, Razia;Wright, Neil
通讯作者：
Wright, Neil