Dhabali Abdullah A H, Awang Rahmat, Hamdan Zulham, Zyoud Sa'ed H
National Poison Centre, Universiti Sains Malaysia, Penang, Malaysia.
Int J Clin Pharmacol Ther. 2012 Dec;50(12):851-61. doi: 10.5414/CP201689.
The objectives of this study were 1) to obtain information regarding the prescribing pattern of nonsteroidal anti-inflammatory drugs (NSAIDs) in the primary care setting at a Malaysian university, 2) to determine the prevalence and types of potential NSAID prescription related problems (PRPs), and 3) to identify patient characteristics associated with exposure to these potential PRPs.
We retrospectively collected data from 1 academic year using the electronic medical records of patients in the University Sains Malaysia (USM) primary care system. The defined daily dose (DDD) methodology and the anatomical therapeutic chemical (ATC) drug classification system were used in the analysis and comparison of the data. Statements representing potential NSAID PRPs were developed from authoritative drug information sources. Then, algorithms were developed to screen the databases for these potential PRPs. Descriptive and comparative statistics were used to characterize DRPs.
During the study period, 12,470 NSAID prescriptions were prescribed for 6,509 patients (mean ± SD = 1.92 ± 1.83). This represented a prevalence of 35,944 per 100,000 patients, or 36%. Based on their DDDs, mefenamic acid and diclofenac were the most prescribed NSAIDs. 573 potential NSAID-related PRPs were observed in a cohort of 432 patients, representing a prevalence of 6,640 per 100,000 NSAIDs users, or 6.6% of all NSAID users. Multivariate logistic regression analysis revealed that patients with a Malay ethnic background (p < 0.001), members of the staff (p < 0.001), having 4 or more prescribers (p < 0.001) or having 2 - 3 prescribers (p = 0.02), and representing 4 or more long-term therapeutic groups (LTTGs) (p < 0.001) or 2 - 3 LTTGs (p < 0.001) were significantly associated with an increased chance of exposure to potential NSAID related PRPs.
This is the first study in Malaysia that presents data on the prescribing pattern of NSAIDs and the characteristics of potential NSAID-related PRPs. The prevalence of potential NSAID-related PRPs is frequent in the primary care setting. Exposure to these PRPs is associated with specific sociodemographic and health status factors. These results should help to raise the awareness of clinicians and patients about serious NSAID PRPs.
本研究的目的是：1）获取马来西亚一所大学初级保健机构中非甾体抗炎药（NSAIDs）的处方模式信息；2）确定潜在的NSAIDs处方相关问题（PRPs）的患病率及类型；3）识别与这些潜在PRPs暴露相关的患者特征。
我们使用马来西亚理科大学（USM）初级保健系统中患者的电子病历，回顾性收集了1个学年的数据。在数据的分析和比较中使用了限定日剂量（DDD）方法和解剖学治疗学化学（ATC）药物分类系统。代表潜在NSAIDs PRPs的陈述是从权威药物信息来源中制定的。然后，开发算法以在数据库中筛选这些潜在的PRPs。使用描述性和比较性统计来描述DRPs。
在研究期间，为6509名患者开出了12470份NSAIDs处方（均值±标准差=1.92±1.83）。这相当于每100000名患者中有35944例，即36%。根据其DDD值，甲芬那酸和双氯芬酸是处方最多的NSAIDs。在432名患者中观察到573例潜在的NSAIDs相关PRPs，相当于每100000名NSAIDs使用者中有6640例，占所有NSAIDs使用者的6.6%。多因素逻辑回归分析显示，马来族裔背景的患者（p<0.001）、工作人员（p<0.001）、有4名或更多开处方者（p<0.001）或有2 - 3名开处方者（p = 0.02），以及属于4个或更多长期治疗组（LTTGs）（p<0.001）或2 - 3个LTTGs（p<0.001）与暴露于潜在NSAIDs相关PRPs的几率增加显著相关。
这是马来西亚第一项提供NSAIDs处方模式数据以及潜在NSAIDs相关PRPs特征的研究。在初级保健机构中，潜在的NSAIDs相关PRPs患病率较高。暴露于这些PRPs与特定的社会人口统计学和健康状况因素有关。这些结果应有助于提高临床医生和患者对严重NSAIDs PRPs的认识。
