Abraham Neena S, El-Serag Hashem B, Johnson Michael L, Hartman Christine, Richardson Peter, Ray Wayne A, Smalley Walter
Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center, Texas 77030, USA.
Gastroenterology. 2005 Oct;129(4):1171-8. doi: 10.1053/j.gastro.2005.08.003.
BACKGROUND & AIMS: Our objective was to assess adherence to evidence-based guidelines by providers of the Department of Veterans Affairs nationwide.
This was a cross-sectional study among veterans prescribed a nonsteroidal anti-inflammatory drug (NSAID) from January 1, 2002, to December 31, 2002. Prescription data were linked to inpatient and outpatient medical records and death files. The population was characterized as high risk based on the following: age 65 years or older, concurrent corticosteroid or anticoagulant use, history of peptic ulcer, and high average daily dose of NSAIDs. Adherence was defined as the prescription of a traditional NSAID with gastroprotection or a coxib in high-risk NSAID users. Univariate and multivariate analyses assessed the potential predictors of adherence.
Three hundred three thousand seven hundred eighty-seven met our definition of high risk. Most (97.3%) were male; 55.6% were white, 9.6% black, and 34.8% of other/unknown race. Age 65 years or older was the largest high-risk subset (87.1%). Overall, only 27.2% of high-risk veterans (n = 82,766) were prescribed an adherent strategy. Among veterans with at least 2 risk factors, adherence was 39.7%; among those with 3 risk factors, adherence was 41.8%. Predictors of adherence included history of upper gastrointestinal events, anticoagulant use, rheumatologic disease, high Deyo comorbidity index score, use of low-dose salicylates, and concurrent corticosteroid use. Predictors of nonadherence included prescriptions > or =90 days and high average daily dose of NSAIDs.
Adherence to evidence-based guidelines for safe prescription of NSAIDs in the Department of Veterans Affairs is low (27.2%). The likelihood of adherence is further decreased if veterans are prescribed NSAIDs for > or=90 days.
我们的目标是评估美国退伍军人事务部全国范围内的医疗服务提供者对循证指南的遵循情况。
这是一项针对2002年1月1日至2002年12月31日期间开具非甾体抗炎药（NSAID）处方的退伍军人的横断面研究。处方数据与住院和门诊病历以及死亡档案相关联。根据以下情况将人群定义为高危人群：年龄在65岁及以上、同时使用皮质类固醇或抗凝剂、有消化性溃疡病史以及NSAIDs的日均剂量较高。遵循情况定义为高危NSAID使用者开具具有胃保护作用的传统NSAID或昔布类药物的处方。单因素和多因素分析评估了遵循情况的潜在预测因素。
303,787人符合我们对高危人群的定义。大多数（97.3%）为男性；55.6%为白人，9.6%为黑人，34.8%为其他/种族不明。65岁及以上是最大的高危亚组（87.1%）。总体而言，只有27.2%的高危退伍军人（n = 82,766）开具了遵循策略的处方。在至少有2个危险因素的退伍军人中，遵循率为39.7%；在有3个危险因素的退伍军人中，遵循率为41.8%。遵循情况的预测因素包括上消化道事件病史、抗凝剂使用、风湿性疾病、高迪尤合并症指数评分、低剂量水杨酸盐的使用以及同时使用皮质类固醇。不遵循情况的预测因素包括处方时长≥90天以及NSAIDs的日均剂量较高。
美国退伍军人事务部对NSAIDs安全处方的循证指南遵循率较低（27.2%）。如果退伍军人的NSAIDs处方时长≥90天，遵循的可能性会进一步降低。
