新证据对处方模式的影响。

Influence of new evidence on prescription patterns.

作者信息

Calvo Cecilia Beatriz, Rubinstein Adolfo

机构信息

Division of Family and Preventive Medicine, Hospital Italiano, Universidad de Buenos Aires, Argentina.

出版信息

J Am Board Fam Pract. 2002 Nov-Dec;15(6):457-62.

PMID:12463291

Abstract

BACKGROUND

It is currently accepted that no drug can enter clinical practice without proved efficacy in clinical trials. Improving patient care requires that the results of clinical evaluation be translated into practice. Results of studies are conflicting, but there is support that well-executed, clinically relevant randomized trials published in highly visible clinical journals can have an effect on patterns of medical practice.

METHODS

We evaluated the potential impact of the publication in a leading journal of different drug studies (metformin, alendronate, terazosin, and finasteride) on the prescription behavior of generalists and specialists. Using a health maintenance organization (HMO) prescription drug database, we analyzed the incidence of new prescriptions written by generalists and specialists from a university-affiliated HMO before and after the publication date of the studies.

RESULTS

The proportions of new prescriptions changed between a 6-month period before publication and a 6-month period after publication. The rate for alendronate increased from 31.7% to 43.2% of all prescriptions for specialists (P = NS) and from 8.8% to 38.9% for generalists (P < .01). The rate for metformin increased from 26.7% to 46.4% for specialists (P = .04) and from 7.9% to 24.2% for generalists (P < .01). The rate for alpha1-blockers decreased from 48.7% to 38.9% (P = NS) for specialists and increased from 20.7% to 60% for generalists (P < .01). The rate for finasteride decreased from 40.9% to 19.64% for specialists (P < .01) and from 22.11% to 11.3% for generalists (P = .01).

CONCLUSIONS

The change in the prescription patterns of all physicians showed a clear temporal association with the publication of new evidence. The greater change observed for generalists could be explained by their lower baseline use of the drugs and a more conservative behavior that might defer the adoption of new treatments until they are supported by strong evidence published in major journals.

摘要

背景

目前公认的是，没有在临床试验中证实疗效的药物无法进入临床应用。改善患者护理需要将临床评估结果转化为实际行动。研究结果相互矛盾，但有证据表明，在高知名度临床期刊上发表的精心设计且具有临床相关性的随机试验能够对医疗实践模式产生影响。

方法

我们评估了在某领先期刊上发表的不同药物研究（二甲双胍、阿仑膦酸盐、特拉唑嗪和非那雄胺）对全科医生和专科医生处方行为的潜在影响。利用一个健康维护组织（HMO）的处方药数据库，我们分析了大学附属HMO的全科医生和专科医生在研究发表日期前后开具新处方的发生率。

结果

新处方比例在发表前6个月和发表后6个月期间发生了变化。阿仑膦酸盐在专科医生所有处方中的比例从31.7%增至43.2%（P=无统计学意义），在全科医生中从8.8%增至38.9%（P<.01）。二甲双胍在专科医生中的比例从26.7%增至46.4%（P=.04），在全科医生中从7.9%增至24.2%（P<.01）。α1阻滞剂在专科医生中的比例从48.7%降至38.9%（P=无统计学意义），在全科医生中从20.7%增至60%（P<.01）。非那雄胺在专科医生中的比例从40.9%降至19.64%（P<.01），在全科医生中从22.11%降至11.3%（P=.01）。