Blumenstein I, Bock H, Weber C, Rambow A, Tacke W, Kihn R, Pfaff R, Orlemann S, Schaeffer R, Schröder O, Dignass A, Hartmann F, Stein J
Division of Gastroenterology, J. W. Goethe-University, Frankfurt/Main, Germany.
Inflamm Bowel Dis. 2008 Jan;14(1):53-60. doi: 10.1002/ibd.20257.
Studies examining the treatment reality of IBD patients in Germany have been limited, as networking among deliverers of care and reliable documentation of medical, demographic, and economic data are lacking. The aim of the present study was to establish an internet-based treatment registry in order to evaluate treatment of IBD patients in Germany.
Between November 1(st), 2005, and January 31, 2007, 1024 outpatients with prevalent IBD from 10 gastroenterological private practices and 3 hospitals (UC = 439, CD = 567, ID = 18) were enrolled in the study. An internet-based registry was established that included data about medical history, disease status, diagnostic procedures, laboratory test results, and medical treatment. Data for private practices and hospitals were pooled in order to compare treatment habits between these types of medical facilities. The cost of medication was determined according to medications prescribed.
There was no significant difference between the 2 patient groups in demographic and clinical characteristics. Marked differences were observed in medical treatment. The most frequently prescribed medications in the private practices for patients in remission and those with active disease were aminosalicylates and corticosteroids. Immunomodulators played a marginal role. In contrast, in the hospitals azathioprine/6-MP was predominantly used for the maintenance of remission. Patients with fistulizing CD were treated with infliximab. The mean annual cost of medications was 1826 +/- 1331euro/patient (median 1353euro) in the private practices and 1849euro +/- 2897euro/patient (median 960euro) at the University Hospital.
The registry provides the first detailed data about the reality of treatment of IBD patients in Germany and reveals the necessity for networking among attending physicians in order to implement guidelines-conformed treatment.
由于医疗服务提供者之间缺乏协作以及医疗、人口统计学和经济数据的可靠记录，对德国炎症性肠病（IBD）患者治疗现状的研究一直有限。本研究的目的是建立一个基于互联网的治疗登记系统，以评估德国IBD患者的治疗情况。
在2005年11月1日至2007年1月31日期间，来自10家胃肠病私人诊所和3家医院的1024例IBD门诊患者（溃疡性结肠炎[UC]=439例，克罗恩病[CD]=567例，未定型结肠炎[ID]=18例）纳入研究。建立了一个基于互联网的登记系统，其中包括病史、疾病状态、诊断程序、实验室检查结果和医疗治疗等数据。将私人诊所和医院的数据汇总，以比较这些类型医疗机构之间的治疗习惯。根据所开处方确定药物费用。
两组患者在人口统计学和临床特征方面无显著差异。在医疗治疗方面观察到明显差异。私人诊所中，缓解期患者和活动期疾病患者最常开具的药物是氨基水杨酸类药物和皮质类固醇。免疫调节剂作用较小。相比之下，在医院中，硫唑嘌呤/6-巯基嘌呤主要用于维持缓解。伴有瘘管形成的CD患者接受英夫利昔单抗治疗。私人诊所中患者的年平均药物费用为1826±1331欧元/患者（中位数1353欧元），大学医院为1849欧元±2897欧元/患者（中位数960欧元）。
该登记系统提供了德国IBD患者治疗现状的首批详细数据，并揭示了主治医生之间进行协作以实施符合指南治疗的必要性。
