Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
Eur J Gastroenterol Hepatol. 2011 Aug;23(8):664-70. doi: 10.1097/MEG.0b013e328347d503.
A health insurance-initiated programme to improve cost-effectiveness of acid-suppressing drugs (ASDs).
To evaluate the effect of two different interventions of general practitioner support in reducing drug prescription.
A sequential cluster randomized controlled trial with 90 participating general practitioners in a telephone support (TS) group or practice visit (PV) group. TS group received support in phase-1 (first 6 months), but served as control group in phase-2 (6-12 months period). PV group received no intervention in phase-1, serving as the control group for the TS group, but received support in phase-2. Prescription data were extracted from Agis Health Insurance Database. Outcomes were the proportion of responders to drug reduction and the number of defined daily dose (DDD). Differences in users and DDD were analysed using multilevel regression analysis.
At baseline, 3424 patients used ASD chronically (211 DDDs, on average). The difference between TS and control groups among responders was 3.2% [95% confidence interval (CI): 0.8; 5.6] and relative risk was 1.26 (95% CI: 1.06; 1.51). The difference between PV and control groups was not relevant (0.4%, 95% CI: -1.99; 2.79 and relative risk: 1.01, 95% CI: 0.82; 1.20). The difference in DDD per patient was -3.0 (95% CI: -8.9; 2.9) and -5.82 (95% CI: -12.4; 0.73), respectively.
This health insurance company-initiated intervention had a moderate effect on ASD prescription. In contrast to TS, PVs did not seem to reduce ASD prescription rates.
一项医疗保险发起的计划，旨在提高抑酸药物（ASD）的成本效益。
评估两种不同的全科医生支持干预措施对减少药物处方的效果。
一项序贯聚类随机对照试验，共有 90 名参与的全科医生分为电话支持（TS）组或就诊访问（PV）组。TS 组在第一阶段（前 6 个月）接受支持，但在第二阶段（6-12 个月期间）作为对照组。PV 组在第一阶段未接受干预，作为 TS 组的对照组，但在第二阶段接受支持。处方数据从 Agis 健康保险数据库中提取。结果是药物减少的应答者比例和定义日剂量（DDD）数量。使用多层回归分析比较用户和 DDD 的差异。
基线时，3424 名患者长期使用 ASD（平均 211 DDD）。TS 组和对照组之间的应答者差异为 3.2%[95%置信区间（CI）：0.8；5.6]，相对风险为 1.26（95% CI：1.06；1.51）。PV 组和对照组之间的差异无统计学意义（0.4%，95% CI：-1.99；2.79 和相对风险：1.01，95% CI：0.82；1.20）。每位患者的 DDD 差异分别为-3.0（95% CI：-8.9；2.9）和-5.82（95% CI：-12.4；0.73）。
这项医疗保险公司发起的干预措施对 ASD 处方有一定的影响。与 TS 不同，PV 似乎并没有降低 ASD 处方率。
