Atthobari Jarir, Gansevoort Ron T, Visser Sipke T, de Jong Paul E, de Jong-van den Berg Lolkje T W
Department of Social Pharmacy, Pharmacoepidemiology & Pharmacotherapy, Groningen University for Drug Exploration (GUIDE), University of Groningen, Groningen, The Netherlands.
Br J Clin Pharmacol. 2007 Dec;64(6):810-8. doi: 10.1111/j.1365-2125.2007.02988.x.
To evaluate the effect of a cardio-renal screening programme on desired and undue drug use.
Data from the PREVEND cohort (Prevention of REnal and Vascular ENd-stage Disease) were used. The drug use of screened (randomly) selected subjects (n = 2650) was compared with unscreened subjects, matched for age and sex (n = 10 434). Drug use in the overall PREVEND cohort, enriched for albuminuria (n = 6751), was also studied. Screening-related drugs (antihypertensive, antilipidaemic, antidiabetic and antithrombotic) were selected, as well as screening-unrelated drugs (benzodiazepines, drugs for acid-related disorders and painkillers). Time to first prescription after screening is presented as Kaplan-Meier curves.
After 6.5 years of follow-up, the incidence of drug use was not significantly different between the screened, randomly selected and unscreened cohorts. Antihypertensives were used by 21.5 and 20.8%, respectively; antilipidaemic 12.8 and 10.2%, antidiabetics 4.0 and 3.9%, and antithrombotic 11.4 and 12.0%. Screening-unrelated drugs were used at comparable frequencies. Compared with the unscreened cohort, screening-related drugs were prescribed more frequently for subjects in the enriched cohort (25.8, 15.5, 5.5 and 13.5% for antihypertensive, antilipidaemic, antidiabetic and antithrombotic, respectively), whereas screening-unrelated drugs were used at comparable frequencies.
The incidence of drug use did not differ between the screened, randomly selected and unscreened cohorts. Screening does not lead to more drug prescription, thus arguing against the fear of undue medicalization after screening. The data also show that, for screening to be successful, it should be performed in a targeted population, such as one enriched for albuminuria.
评估一项心肾筛查计划对合理用药和过度用药的影响。
使用了PREVEND队列（预防终末期肾病和血管疾病）的数据。将经筛查（随机）选取的受试者（n = 2650）的用药情况与按年龄和性别匹配的未筛查受试者（n = 10434）进行比较。还研究了总体PREVEND队列中因蛋白尿而增多的受试者（n = 6751）的用药情况。选取了与筛查相关的药物（抗高血压药、抗血脂药、抗糖尿病药和抗血栓药）以及与筛查无关的药物（苯二氮䓬类药物、治疗酸相关疾病的药物和止痛药）。筛查后首次处方的时间以Kaplan-Meier曲线表示。
经过6.5年的随访，经筛查的随机选取队列与未筛查队列之间的用药发生率无显著差异。抗高血压药的使用比例分别为21.5%和20.8%；抗血脂药为12.8%和10.2%，抗糖尿病药为4.0%和3.9%，抗血栓药为11.4%和12.0%。与筛查无关的药物使用频率相当。与未筛查队列相比，在增多的队列中，与筛查相关的药物在受试者中的处方频率更高（抗高血压药、抗血脂药、抗糖尿病药和抗血栓药分别为25.8%、15.5%、5.5%和13.5%），而与筛查无关的药物使用频率相当。
经筛查的随机选取队列与未筛查队列之间的用药发生率无差异。筛查不会导致更多的药物处方，因此反对对筛查后过度医疗化的担忧。数据还表明，为使筛查成功，应在目标人群中进行，例如因蛋白尿而增多的人群。
