Hoer Ariane, Behrendt Susann, Schmidt Torsten, Lottmann Kathrin
IGES Institut GmbH, Friedrichstr. 180, D-10117 Berlin, Germany.
Cardiol Res. 2013 Jun;4(3):89-100. doi: 10.4021/cr279e. Epub 2013 Jul 11.
The aim of this study was to determine the health care utilization of patients with acute coronary syndrome (ACS) of one German statutory health insurance. The utilization of ambulatory services as well as of inpatient rehabilitation should be regarded. Moreover, the study should reveal the prescription of drugs for secondary prevention. Here, patients showing guideline corresponding prescriptions should be compared with patients without such prescriptions.
A retrospective claims data analysis of one German statutory health insurance was conducted. Health care utilization was considered in the first year after an index hospitalization due to ACS. Beneficiaries for whom an ICD-10 discharge diagnosis of ACS was reported between January 1st 2007 and December 31st 2009 were included. In order to reveal differences in health care utilization depending on the type of ACS (STEMI versus NSTEMI/UA) stratified analyses were performed. Another stratification was done for patients with and without defined drug prescriptions.
From 45,188 patients with ACS almost three quarters were assigned to the group of NSTEMI/UA. For 8.9% of all ACS patients (18.74% STEMI, 8.89% NSTEMI/UA), inpatient post-hospital rehabilitation related to ACS was recorded. Ambulatory care related to CHD diagnosis was utilized by 77.6% of patients, more often by STEMI than by NSTEMI/UA patients. For 36.7% and 45.7% of ACS patients, a prescription of aspirin or clopidogrel was recorded, respectively, 79.4% of STEMI patients received at least one prescription for antiplatelet drugs, the corresponding proportion of NSTEMI/UA was 59.8%. A considerable part of patients without prescription dropped out within the first 90 days after the index event.
A claims data analysis of one German statutory health insurance fund showed that health care utilization of ACS patients varied depending on the ACS type. It is necessary to distinguish between STEMI and NSTEMI/UA patients when discussing the ambulatory drug utilization.
本研究旨在确定一家德国法定健康保险机构中急性冠状动脉综合征（ACS）患者的医疗保健利用情况。应考虑门诊服务以及住院康复的利用情况。此外，该研究应揭示二级预防药物的处方情况。在此，应将显示符合指南处方的患者与无此类处方的患者进行比较。
对一家德国法定健康保险机构进行回顾性索赔数据分析。在因ACS进行索引住院后的第一年考虑医疗保健利用情况。纳入2007年1月1日至2009年12月31日期间报告有ICD - 10出院诊断为ACS的受益人。为了揭示根据ACS类型（ST段抬高型心肌梗死与非ST段抬高型心肌梗死/不稳定型心绞痛）在医疗保健利用方面的差异，进行了分层分析。对有和无明确药物处方的患者进行了另一分层。
在45188例ACS患者中，近四分之三被归类为非ST段抬高型心肌梗死/不稳定型心绞痛组。在所有ACS患者中，8.9%（ST段抬高型心肌梗死患者为18.74%，非ST段抬高型心肌梗死/不稳定型心绞痛患者为8.89%）记录了与ACS相关的住院后康复情况。77.6%的患者利用了与冠心病诊断相关的门诊护理，ST段抬高型心肌梗死患者比非ST段抬高型心肌梗死/不稳定型心绞痛患者更常利用。分别有36.7%和45.7%的ACS患者记录了阿司匹林或氯吡格雷的处方，79.4%的ST段抬高型心肌梗死患者至少接受了一种抗血小板药物处方，非ST段抬高型心肌梗死/不稳定型心绞痛患者的相应比例为59.8%。相当一部分无处方的患者在索引事件后的前90天内退出。
对一家德国法定健康保险基金的索赔数据分析表明，ACS患者的医疗保健利用情况因ACS类型而异。在讨论门诊药物利用情况时，有必要区分ST段抬高型心肌梗死和非ST段抬高型心肌梗死/不稳定型心绞痛患者。
