Penfold Robert B, Kelleher Kelly J
Columbus Children's Research Institute, Columbus, Ohio 43205, USA.
Clin Ther. 2007 Feb;29(2):359-70; discussion 358. doi: 10.1016/j.clinthera.2007.02.017.
The purpose of this study was to examine the diffusion of olanzapine to urban and rural children insured by Medicaid in Michigan by identifying prescribing clusters through surveillance of claims records.
Prescription claims records for all antipsychotic medications for 3,567 children insured by Medicaid in Michigan from 1996 through 1998 were examined through the state Medicaid database. There were 29,069 pediatric prescriptions for antipsychotic medications; 2949 were for olanzapine (576 children, 510 providers). These data were linked to the Area Resource File, Provider Enrollment File, and Rural-Urban Commuting Area codes. Patient and provider locations were geocoded by ZIP code. Mixed logistic regression analysis was performed to determine the probability of a child's being prescribed olanzapine given certain community, patient, and provider characteristics. Spatial clusters were identified through the local Moron's L statistic and empirical Bayes standardized incidence rates.
Rural children were more likely than urban children to be prescribed olanzapine (odds ratio [OR], 1.29; P < 0.001). There were significant differences by age and sex, with older children and girls more likely than younger children and boys to be prescribed olanzapine (OR, 1.30 and 1.37, respectively; both, P < 0.001). At the county level, the number of pediatricians per primary care physician reduced the likelihood of a child's being prescribed olanzapine (OR, 0.88; P = 0.039). The effect of the number of available mental health professionals was not significant. The global Moran's L statistic was U indicating moderate clustering of the use of olanzapine.
Graphic surveillance data may be useful for studying the delivery and use of health cue services. Further research is needed to determine how this method can be used strategically to facilitate or impede the diffusion of new medications.
本研究的目的是通过监测理赔记录来识别处方集群，从而研究奥氮平在密歇根州参加医疗补助计划的城乡儿童中的扩散情况。
通过该州医疗补助数据库，检查了1996年至1998年密歇根州3567名参加医疗补助计划儿童的所有抗精神病药物处方理赔记录。共有29069份儿科抗精神病药物处方；其中2949份是奥氮平处方（涉及576名儿童和510名开处方者）。这些数据与地区资源文件、提供者注册文件以及城乡通勤区代码相关联。患者和提供者的位置通过邮政编码进行地理编码。进行了混合逻辑回归分析，以确定在特定社区、患者和提供者特征下儿童被开奥氮平处方的概率。通过局部莫兰氏L统计量和经验贝叶斯标准化发病率来识别空间集群。
农村儿童比城市儿童更有可能被开奥氮平（优势比[OR]，1.29；P<0.001）。在年龄和性别方面存在显著差异，年龄较大的儿童和女孩比年龄较小的儿童和男孩更有可能被开奥氮平（OR分别为1.
