Herrmann Nathan, Gill Sudeep S, Bell Chaim M, Anderson Geoffrey M, Bronskill Susan E, Shulman Kenneth I, Fischer Hadas D, Sykora Kathy, Shi Haijiang Steven, Rochon Paula A
Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
J Am Geriatr Soc. 2007 Oct;55(10):1517-23. doi: 10.1111/j.1532-5415.2007.01377.x. Epub 2007 Aug 14.
To examine current utilization patterns of cholinesterase inhibitor (ChEI) therapy for dementia to determine treatment duration, use in long-term care, how often patients receive these drugs until death, and frequency of switching between the available ChEIs.
A population-based healthcare administrative database study.
Patients aged 66 and older from the Canadian province of Ontario who received a new prescription for a ChEI between June 1, 2000, and December 31, 2002. Patients were followed until discontinuation of ChEI therapy, death, or end of the observation period (March 31, 2005).
Twenty-eight thousand nine hundred and sixty-one patients, including 4,601 residing in long-term care, mean age 80, 63% female.
Information on diagnosis, medical comorbidity, physician visits, and concomitant medication use was obtained. Estimates of duration of continuous use were determined. The percentage of patients who remained on the initial dose prescribed, the proportion who switched to a second ChEI, and the percentage who remained on ChEIs until death were calculated.
Patients had on average more than 26 physician visits in the year before ChEI therapy, but only 28% had seen a dementia specialist. Concomitant use of potentially inappropriate medications (strongly anticholinergic medications and benzodiazepines) was noted in 37% of patients. The average length of treatment for all patients was 866 days. Many patients (43%) remained on the initial dose prescribed, 6% switched to another ChEI, and 19% died while on ChEI therapy.
Elderly patients with dementia are treated for lengthy periods of time with ChEIs in the community and in long-term care facilities. Further research is required to determine whether these utilization patterns are appropriate. It is also unclear whether these results are generalizable to other populations without universal health coverage or drug formulary benefits.
研究目前用于治疗痴呆症的胆碱酯酶抑制剂（ChEI）疗法的使用模式，以确定治疗持续时间、在长期护理中的使用情况、患者直至死亡前接受这些药物治疗的频率，以及在可用的胆碱酯酶抑制剂之间转换的频率。
一项基于人群的医疗管理数据库研究。
来自加拿大安大略省年龄在66岁及以上的患者，于2000年6月1日至2002年12月31日期间首次开具了胆碱酯酶抑制剂处方。对患者进行随访，直至胆碱酯酶抑制剂治疗中断、死亡或观察期结束（2005年3月31日）。
28961名患者，其中4601名居住在长期护理机构，平均年龄80岁，女性占63%。
获取有关诊断、合并症、医生诊疗次数和同时使用药物的信息。确定连续使用时间的估计值。计算维持初始处方剂量的患者百分比、改用第二种胆碱酯酶抑制剂的比例以及直至死亡时仍在使用胆碱酯酶抑制剂的患者百分比。
在接受胆碱酯酶抑制剂治疗前的一年中，患者平均看诊次数超过26次，但只有28%的患者看过痴呆症专科医生。37%的患者同时使用了潜在不适当的药物（强效抗胆碱能药物和苯二氮䓬类药物）。所有患者的平均治疗时长为866天。许多患者（43%）维持初始处方剂量，6%改用了另一种胆碱酯酶抑制剂，19%在接受胆碱酯酶抑制剂治疗期间死亡。
社区和长期护理机构中的老年痴呆症患者接受胆碱酯酶抑制剂治疗的时间较长。需要进一步研究以确定这些使用模式是否恰当。同样不清楚这些结果是否适用于其他没有全民医保或药物处方福利的人群。
