Grimmsmann Thomas, Schwabe Ulrike, Himmel Wolfgang
Medical Review Board of the Statutory Health Insurance Funds Mecklenburg-Vorpommern, Lessingstr. 31, 19059, Schwerin, Germany.
Eur J Clin Pharmacol. 2007 Aug;63(8):783-90. doi: 10.1007/s00228-007-0325-1. Epub 2007 Jun 5.
To explore the influence of hospitalisation on the prescription of drugs in the primary care sector using prescription data of a major statutory health insurance (SHI) organisation, with a special focus on the so-called "Me-Too" drugs - in particular, 3-hydroxy-3-methyl-glutaryl (HMG) CoA reductase inhibitors (statins) and proton pump inhibitors (PPIs).
A comprehensive outpatient drug prescription analysis was conducted on members of a SHI who had been hospitalised during the first 3 months of 2004. The number and costs of all prescriptions of 2426 patients during a 3-month period before admission and after discharge, respectively, were compared using Wilcoxon's signed rank test. Data are shown in absolute and relative numbers as well as relative risks (RR) and their 95% confidence intervals (CIs).
The total number of prescriptions before hospitalisation and after discharge remained nearly the same, while the number of different active substances prescribed per patient decreased by 4%. However, overall costs increased after discharge by 15% due to the higher cost per prescription. Changes in medication affected nearly every patient (98.1%), and 60% had at least five changes. Of the substances prescribed to an individual before admission, 57% were cancelled after discharge, and 55% of all substances prescribed after discharge were novel prescriptions. Significantly more patients received a PPI or statin after hospitalisation (RR for a PPI: 1.27; 95% CI: 1.12 -1.45; RR for a statin: 1.16; 95% CI: 1.02-1.32). The increase in PPI medication was due to a 58% increase in the number of patients receiving pantoprazole, a "Me-Too" drug.
Hospitalisation exerts a marked influence on drug therapy in ambulatory care, with a significant increase in the prescription of novel, on-patent drugs instead of less expensive alternatives.
利用一家主要法定医疗保险（SHI）机构的处方数据，探讨住院治疗对基层医疗部门药物处方的影响，特别关注所谓的“Me-Too”药物——尤其是3-羟基-3-甲基戊二酰辅酶A（HMG）还原酶抑制剂（他汀类药物）和质子泵抑制剂（PPIs）。
对2004年第一季度住院的SHI成员进行全面的门诊药物处方分析。分别使用Wilcoxon符号秩检验比较了2426名患者入院前和出院后3个月期间所有处方的数量和费用。数据以绝对数和相对数以及相对风险（RR）及其95%置信区间（CIs）表示。
住院前后的处方总数基本保持不变，但每位患者开具的不同活性物质数量减少了4%。然而，由于每张处方费用较高，出院后的总体费用增加了15%。用药变化几乎影响了每一位患者（98.1%），60%的患者至少有五项变化。入院前开具给个体的物质中，57%在出院后被停用，出院后开具的所有物质中有55%是新处方。住院后显著更多的患者接受了PPI或他汀类药物治疗（PPI的RR：1.27；95%CI：1.12 - 1.45；他汀类药物的RR：1.16；95%CI：1.02 - 1.32）。PPI用药的增加是由于接受泮托拉唑（一种“Me-Too”药物）治疗的患者数量增加了58%。
住院治疗对门诊护理中的药物治疗有显著影响，新型专利药物的处方显著增加，而不是使用成本较低的替代药物。
