Vetvik K, Straand J
Institutt for indremedisin, Avdeling Diakonissehjemmets sykehus, Haraldsplass, Universitetet i Bergen, 5009 Bergen.
Tidsskr Nor Laegeforen. 2001 Feb 20;121(5):557-62.
The introduction of acid suppressant, cytoprotective and prokinetic drugs represented major progress in the treatment of acid-related diseases. In Norway, these drugs were reimbursed by the National Insurance System (NIS) from 1986. However, even if the distribution of the various diagnostic indications for prescribing were lacking, this reimbursement was stopped in 1995. The aim of this study was to describe prescriptions for presumed licensed diagnostic indications of these drugs for a defined population, and analyse them with regard to patients characteristics, verified (endoscopic) diagnoses, and therapeutic guidelines.
All prescriptions issued in 1994 to inhabitants of Lindesnes and Mandal Municipalities (17,105 inhabitants) were retrospectively retrieved from the pharmacies and the NIS. The medical records of the local endoscopy units and roentgen laboratories were subsequently searched for information on diagnostic procedures and final diagnosis leading to the prescriptions for these patients.
A total number of 1,128 prescriptions (87,905 DDDs) were issued to 441 patients (3% of the population at risk; mean age 63 years; 55% men), and more commonly for the elderly (for 11% of those aged 80 years or more). Diagnostic procedures were documented for 93% of the patients (upper endoscopy in 404, 92%). Diagnostic indications for prescribing were reflux oesophagitis (48%), duodenal ulcer (24%), gastric ulcer (13%), and dyspepsia with normal endoscopic findings (12%). The drugs issued were H2-receptor antagonists (59%), proton pump inhibitors (31%), and cisapride (10%). 8% of the patients were long-term users of an NSAID. Of the 441 patients, drug treatment was issued to 38 with normal endoscopic findings and to 31 patients in whom we could not document examination by endoscopy or X-ray.
This study supports that the prevalence of dyspeptic complaints calling for drug treatment increases with patient age. With minor exceptions we found that the prescribing practice for the different diagnoses is in accordance with established therapeutic guidelines.
抑酸药、细胞保护药和促动力药的引入代表了酸相关性疾病治疗的重大进展。在挪威，自1986年起这些药物可通过国家保险系统（NIS）报销。然而，即使缺乏各类诊断指征的处方分布情况，1995年该报销政策仍被终止。本研究的目的是描述针对特定人群开具的这些药物假定许可诊断指征的处方情况，并就患者特征、经证实（内镜）的诊断以及治疗指南对其进行分析。
从药房和国家保险系统中回顾性检索1994年开具给林德斯内斯和曼达尔市居民（17,105名居民）的所有处方。随后在当地内镜检查单位和放射实验室的病历中查找有关诊断程序和导致这些患者处方的最终诊断的信息。
共向441名患者开具了1,128张处方（87,905限定日剂量）（占风险人群的3%；平均年龄63岁；55%为男性），且更常见于老年人（80岁及以上人群的11%）。93%的患者记录了诊断程序（404例进行了上消化道内镜检查，占92%）。处方的诊断指征为反流性食管炎（48%）、十二指肠溃疡（24%）、胃溃疡（13%）以及内镜检查结果正常的消化不良（12%）。所开具的药物为H2受体拮抗剂（59%）质子泵抑制剂（31%）和西沙必利（10%）。8%的患者长期使用非甾体抗炎药。在441名患者中，内镜检查结果正常的38名患者以及无法记录其内镜或X线检查情况的31名患者接受了药物治疗。
本研究支持需要药物治疗的消化不良症状的患病率随患者年龄增加而上升。除了少数例外情况，我们发现不同诊断的处方开具实践符合既定的治疗指南。
