Morrato Elaine H, Staffa Judy A
University of Colorado at Denver and Health Sciences Center, Denver, CO, USA.
Pharmacoepidemiol Drug Saf. 2007 Jan;16(1):104-12. doi: 10.1002/pds.1279.
To assess the effectiveness of a pharmaceutical risk management plan using pemoline as a case study and pharmacy claims as the data source.
Prescription claims from a continuously enrolled US population (September 1, 2000-September 30, 2002) from Caremark, a pharmacy benefit manager, were evaluated for patients with one or more pemoline claims. Patients were categorized using pemoline as second-line or first-line therapy depending on presence or absence of other central nervous system (CNS) stimulants prescriptions 90 days prior to the first pemoline claim. Logistic regression was performed to compare second-line and first-line usage with regard to patient age, gender and prescribing physician specialty and region of practice.
Of 1,279,296 prescription claims for CNS stimulants, 17,256 (1.3%) were for pemoline. Nine hundred thirteen patients received pemoline and had 90 days or more prior enrollment. Overall, 10% of patients receiving pemoline received it as second-line therapy (95%CI: 8-12%). After adjusting for age, gender, specialty, and region, the odds of receiving pemoline as second-line therapy were significantly greater in pediatrics relative to adults (OR = 2.82, 95%CI: 1.58-5.03), and among those whose prescribers were psychiatrists versus primary care physicians (OR = 2.48, 95%CI: 1.37-4.50). Children treated by a psychiatrist had the greatest likelihood for use as second-line therapy (36%, 95%CI: 19-56%).
Among patients who received pemoline, concordance with second-line therapy recommendations was low, even among the primary target audience of children. These results in a large geographically diverse patient population are consistent with an earlier regional study.
以匹莫林为例，使用药房索赔数据作为数据源，评估药物风险管理计划的有效性。
对来自药房福利管理公司Caremark的连续参保美国人群（2000年9月1日至2002年9月30日）的处方索赔进行评估，筛选出有一项或多项匹莫林索赔的患者。根据首次匹莫林索赔前90天是否存在其他中枢神经系统（CNS）兴奋剂处方，将患者分为匹莫林二线治疗或一线治疗。进行逻辑回归分析，比较二线和一线治疗在患者年龄、性别、开处方医生专业和执业地区方面的使用情况。
在1,279,296份中枢神经系统兴奋剂处方索赔中，17,256份（1.3%）是匹莫林的索赔。913名患者接受了匹莫林治疗，且在治疗前已参保90天或更长时间。总体而言，接受匹莫林治疗的患者中有10%接受的是二线治疗（95%置信区间：8 - 12%）。在调整年龄、性别、专业和地区后，儿科患者接受匹莫林二线治疗的几率相对于成人显著更高（比值比 = 2.82，95%置信区间：1.58 - 5.03），并且在开处方医生为精神科医生的患者中相对于初级保健医生而言接受二线治疗的几率也更高（比值比 = 2.48，95%置信区间：1.37 - 4.50）。由精神科医生治疗的儿童使用二线治疗的可能性最大（36%，95%置信区间：19 - 56%）。
在接受匹莫林治疗的患者中，即使在主要目标人群儿童中，符合二线治疗推荐的比例也较低。在地域分布广泛的大量患者群体中得到的这些结果与早期的一项地区性研究一致。
