Pefoyo A J Kone, Laurier C, Rivard M
Département de médecine sociale et préventive, université de Montréal, Montréal, Canada.
Rev Mal Respir. 2010;27(1):49-62. doi: 10.1016/j.rmr.2009.11.005. Epub 2009 Dec 16.
The study of geographic variations in the use of medication can constitute an interesting and useful option in public health surveillance for the identification of population needs and for the fair partition of resources. Many studies report variations in the use of medication that are not always understood. Considering the importance of medication, particularly for chronic diseases like asthma, it is important to identify factors that can explain geographic differences in the utilization of medications in order to determine optimal prescription practices.
We used a multilevel analysis to explore determinants of variation among welfare recipients and subscribers covered by the Quebec public drug plan, aged five to 44, who claimed at least one prescription for an asthmatic medication in 2003. The analysis was based on 73 small areas in Quebec's 15 health regions.
Prevalence of usage and hospitalization rates are the main predictors of variation in medication intensity. On the other hand, prevalence of usage is related to the area of residence, proportion of welfare recipients and prevalence of smokers. The quality of medication is related to practitioners' specialty.
Different factors contribute to the understanding of geographic variations in asthma medication but it remains important to control for severity. Small area analysis makes it possible to identify specific areas facing more important problems in the prevalence and use of medication for asthma and thus leads to better understanding of local needs for more targeted interventions.
药物使用的地理差异研究在公共卫生监测中是一种有趣且有用的选择，可用于确定人群需求以及合理分配资源。许多研究报告了药物使用的差异，但这些差异往往难以理解。鉴于药物的重要性，尤其是对于哮喘等慢性病，识别能够解释药物使用地理差异的因素以确定最佳处方实践非常重要。
我们采用多层次分析来探究2003年年龄在5至44岁、参加魁北克公共药物计划且至少申领过一张哮喘药物处方的福利领取者和参保者之间差异的决定因素。该分析基于魁北克15个健康区域的73个小区域。
使用率和住院率是药物使用强度差异的主要预测因素。另一方面，使用率与居住地区、福利领取者比例和吸烟者患病率有关。药物质量与从业者的专业有关。
不同因素有助于理解哮喘药物使用的地理差异，但控制病情严重程度仍然很重要。小区域分析能够识别出在哮喘药物患病率和使用方面面临更重要问题的特定区域，从而更好地理解当地需求以便进行更有针对性的干预。
