Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Number 325, Section 2, Cheng-Gong Road, Neihu 114, Taipei, Taiwan.
Int J Clin Pharm. 2012 Oct;34(5):710-8. doi: 10.1007/s11096-012-9664-9. Epub 2012 Jul 10.
The geographical location and medical facility may affect the pattern of antihypertensive prescriptions. Information regarding the correlation between the prescription and health care faculties in different geographical locations was lacking.
The aim of this study was to compare differences in the prescribing of antihypertensives between hospital-based clinics (hospital arm) and office-based clinics (office arm) in different geographical locations in Taiwan.
We collected data from the National Health Insurance database of Taiwan to carry out a population-based, retrospective cohort analysis of 3,218,794 patients newly diagnosed with hypertension in the period January 1, 1997 to December 31, 2004. Eligible participants were classified into either of two groups based on the level of health care faculty: hospital arm and office arm. The covariates composed of age, gender, antihypertensive regimens, urbanization status, comorbidity, and Charlson comorbidity index.
There were 2,028,784 cases (63.0 %) for the hospital arm and 1,190,010 (37 %) for the office arm. In the hospital-based arm, there were 168,933 (8.3 %) patients diagnosed with diabetes mellitus, 166,110 (8.2 %) patients diagnosed with coronary artery disease, 147,465 (7.3 %) patients diagnosed with cerebrovascular accident, 86,866 (4.3 %) patients diagnosed with chronic kidney disease, 74,525 (3.7 %) patients diagnosed with benign prostatic hyperplasia, 55,517 (2.7 %) patients diagnosed with congestive heart failure. The all comorbidities in the hospital arm had significantly higher proportions than those in the office arm (p < 0.001). The Charlson comorbidity index in the hospital arm was higher than that in the office arm (p < 0.001). Physicians who practiced in the office arm prescribed polytherapy less often than those in the hospital arm (OR = 0.68, 95 % CI: 0.67-0.68). For overall urbanization status, the adjusted OR of polytherapy prescriptions in the aging city (OR = 1.08, 95 % CI: 1.05-1.12) was higher than other type cities. The highest urbanization-specific OR of polytherapy prescriptions was observed for highly urbanized city in the hospital arm (OR = 1.20, 95 % CI: 1.18-1.23) and aging city in the office arm (OR = 1.42, 95 % CI: 1.21-1.67). In the both arm, patients with lower CCI showed decreased risk of polytherapy prescription.
The antihypertensive prescriptions in the clinical practices were different between the hospital arm and the office arm in the different health care, comorbidity, and urbanization status. During the study period, the proportion of antihypertensive polytherapy had declined.
地理位置和医疗设施可能会影响降压药物的使用模式。有关不同地理位置处方与医疗保健机构之间相关性的信息尚缺乏。
本研究旨在比较台湾不同地理位置的医院诊所（医院组）和诊所（诊所组）之间降压药物使用的差异。
我们从台湾全民健康保险数据库中收集数据，对 1997 年 1 月 1 日至 2004 年 12 月 31 日期间新诊断为高血压的 3,218,794 例患者进行了一项基于人群的回顾性队列分析。合格参与者根据医疗保健机构的水平分为两组：医院组和诊所组。协变量包括年龄、性别、降压方案、城市化程度、合并症和 Charlson 合并症指数。
医院组有 2,028,784 例（63.0%），诊所组有 1,190,010 例（37%）。在医院组中，有 168,933 例（8.3%）患者被诊断为糖尿病，166,110 例（8.2%）患者被诊断为冠状动脉疾病，147,465 例（7.3%）患者被诊断为脑血管意外，86,866 例（4.3%）患者被诊断为慢性肾脏病，74,525 例（3.7%）患者被诊断为良性前列腺增生，55,517 例（2.7%）患者被诊断为充血性心力衰竭。医院组的所有合并症比例明显高于诊所组（p<0.001）。医院组的 Charlson 合并症指数高于诊所组（p<0.001）。在诊所组工作的医生开具联合治疗的可能性低于在医院组工作的医生（OR=0.68，95%CI：0.67-0.68）。对于整体城市化程度，老龄化城市（OR=1.08，95%CI：1.05-1.12）的联合治疗处方调整后的优势比高于其他类型的城市。在医院组中，高度城市化城市（OR=1.20，95%CI：1.18-1.23）和老龄化城市（OR=1.42，95%CI：1.21-1.67）的联合治疗处方的城市化特异性优势比最高。在两组中，CCI 较低的患者联合治疗处方的风险降低。
不同医疗保健、合并症和城市化程度的医院组和诊所组之间的降压药物处方存在差异。在研究期间，降压药物联合治疗的比例有所下降。
