Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
Pharmacoepidemiol Drug Saf. 2011 Apr;20(4):359-65. doi: 10.1002/pds.2094. Epub 2010 Dec 28.
To examine the impact of 2001 and 2005 quality use of medicines (QUMs) diabetes programs implemented by National Prescribing Service (NPS) on the prevalence of utilisation of metformin and insulin among the Australian diabetes veteran population.
A retrospective observational study using Department of Veterans' Affairs pharmacy claims data. Diabetes population was defined as all veterans aged 55 and over who were dispensed medicines indicative of diabetes between 2000 and 2007. Prevalence of utilisation of metformin and insulin were assessed. Time series regression analysis was undertaken to study the effect on drug utilisation of NPS diabetes intervention programs.
Of the diabetes population, over 55% has been dispensed metformin, and around 20% insulin. Across 2000-2007, metformin used as monotherapy has risen from 22.7 to 28.6% of the diabetes population and metformin concurrent with other diabetes medicines has increased from 32.3 to 36.5%. Insulin monotherapy has decreased from 13.9 to 11.5%, while insulin in combination with oral hypoglycaemics has increased from 6.1 to 11.1%. Twenty-four months post the onset of second NPS diabetes intervention, there was 4.2% relative increase in metformin use, and 13.5% relative increase in insulin used concurrently with oral hypoglycaemics, compared to the estimates without the interventions.
Changes in oral hypoglycaemics trends are towards metformin dispensing as part of ongoing diabetes management. Insulin trends have been away from monotherapy and towards concurrent dispensing with oral antidiabetic drugs. NPS QUMs programs for diabetes management were positively associated with these changes.
考察国家处方服务（NPS）于 2001 年和 2005 年实施的 2 项“合理用药（QUM）糖尿病计划”对澳大利亚糖尿病退伍军人人群中二甲双胍和胰岛素使用率的影响。
采用退伍军人事务部药房理赔数据进行回顾性观察性研究。糖尿病患者人群定义为所有年龄在 55 岁及以上、2000 年至 2007 年期间配用糖尿病药物的退伍军人。评估了二甲双胍和胰岛素的使用率。采用时间序列回归分析研究 NPS 糖尿病干预计划对药物使用的影响。
在糖尿病患者人群中，55%以上的患者配用了二甲双胍，约 20%的患者配用了胰岛素。在 2000-2007 年期间，作为单药治疗的二甲双胍使用率从糖尿病患者人群的 22.7%上升至 28.6%，同时与其他糖尿病药物联合使用的比例从 32.3%上升至 36.5%。胰岛素单药治疗的使用率从 13.9%下降至 11.5%，而与口服降糖药联合使用的胰岛素的使用率从 6.1%上升至 11.1%。在第 2 次 NPS 糖尿病干预开始后 24 个月，与没有干预措施时相比，二甲双胍的使用率相对增加了 4.2%，同时与口服降糖药联合使用的胰岛素的使用率相对增加了 13.5%。
口服降糖药的使用趋势逐渐向二甲双胍转变，作为持续糖尿病管理的一部分。胰岛素的使用趋势逐渐从单药治疗向与口服抗糖尿病药物联合使用转变。NPS 的糖尿病管理 QUM 计划与这些变化呈正相关。
