住院和门诊医院环境中促红细胞生成素刺激剂的使用及处方模式。

Use and prescribing patterns for erythropoiesis-stimulating agents in inpatient and outpatient hospital settings.

作者信息

Siegel Jerry, Jorgenson James, Johnson Philip E, Brophy Donald F, Comstock Thomas, Feng Amy, Audhya Paul

机构信息

College of Pharmacy, The Ohio State University Medical Center, Columbus 43210, USA.

出版信息

Am J Health Syst Pharm. 2008 Sep 15;65(18):1711-9. doi: 10.2146/ajhp070526.

DOI:10.2146/ajhp070526

PMID:18768997

Abstract

PURPOSE

Erythropoiesis-stimulating agent (ESA) use in the outpatient and inpatient settings through pharmacist-conducted, hospital-based chart audits is examined and discussed.

METHODS

Data from four hospital chart audits conducted in 250 hospitals between October 2005 and July 2006 were pooled for analyses. Eligible hospitals were categorized by ESA sales volume, with approximately equal numbers randomly selected from each decile. The last five inpatients and outpatients within each specified month receiving either darbepoetin alfa or epoetin alfa were evaluated. Study variables by setting included ESA use, prescriber specialty, and dosage regimen.

RESULTS

The most common hospital locations of ESA administration were a cancer center in the outpatient setting (49%) and general medicine (57%) in the inpatient setting. ESA prescribers were most commonly hematologists and oncologists in the outpatient setting, and nephrologists were the most common prescribers in the inpatient setting. In the outpatient analysis, 2155 patients were prescribed darbepoetin alfa and 3106 were prescribed epoetin alfa. The predominant administration frequencies were every two weeks and once weekly for darbepoetin alfa, and once weekly for epoetin alfa. In the inpatient analysis, 1633 patients were prescribed darbepoetin alfa and 3231 were prescribed epoetin alfa. The predominant administration frequencies were once weekly for darbepoetin alfa and once weekly and three times weekly for epoetin alfa. Common uses for both ESAs were chemotherapy-induced anemia (outpatient setting) and anemia of end-stage renal disease with chronic dialysis (inpatient setting). There was considerable variability in ESA dosages and administration frequencies in both settings within all patient groups when analyzed by specified use.

CONCLUSION

ESA use differed between outpatient and inpatient settings in indication, frequency of administration, and specialty of the prescriber.

摘要

目的

通过药剂师主导的、基于医院的病历审核，对门诊和住院环境中促红细胞生成素（ESA）的使用情况进行研究和讨论。

方法

汇总2005年10月至2006年7月期间在250家医院进行的四次医院病历审核数据进行分析。符合条件的医院按ESA销售量进行分类，从每个十分位数中随机选取数量大致相等的医院。对每个指定月份内接受达贝泊汀α或促红细胞生成素α的最后五名住院患者和门诊患者进行评估。按环境分类的研究变量包括ESA的使用、开处方者的专业和给药方案。

结果

ESA给药最常见的医院科室在门诊是癌症中心（49%），在住院是普通内科（57%）。门诊环境中，ESA开处方者最常见的是血液科医生和肿瘤科医生，住院环境中最常见的开处方者是肾内科医生。在门诊分析中，2155名患者被处方达贝泊汀α，3106名患者被处方促红细胞生成素α。达贝泊汀α的主要给药频率是每两周一次和每周一次，促红细胞生成素α是每周一次。在住院分析中，1633名患者被处方达贝泊汀α，3231名患者被处方促红细胞生成素α。达贝泊汀α的主要给药频率是每周一次，促红细胞生成素α是每周一次和每周三次。两种ESA的常见用途在门诊是化疗引起的贫血，在住院是慢性透析的终末期肾病贫血。按特定用途分析时，所有患者组在两种环境下ESA剂量和给药频率都存在很大差异。