Vitacca Michele, Barbano Luca, Colombo Daniele, Leoni Olivia, Guffanti Enrico
Istituti Clinici Scientifici Maugeri.
Monaldi Arch Chest Dis. 2018 Jan 29;88(1):882. doi: 10.4081/monaldi.2018.882.
Few studies have analyzed the prevalence and accessibility of home mechanical ventilation (HMV) in Italy. We aimed to investigate the prevalence and prescription variability of HMV as well as of long-term oxygen therapy (LTOT) and continuous positive airway pressure (CPAP), in the Lombardy Region. Prescribing rates of HMV (both noninvasive and tracheostomies), CPAP (auto-CPAP, CPAP/other sleep machines) and LTOT (liquid-O2, O2-gas, concentrators) in the 15 Local Healthcare districts of Lombardy were gathered from billing data for 2012 and compared. Crude rates (per 100,000 population) and rates for the different healthcare districts were calculated. In 2012, 6325 patients were on HMV (crude prescription rate: 63/100,000) with a high variation across districts (8/100,000 in Milano 1 vs 150/100,000 in Pavia). There were 14,237 patients on CPAP (crude prescription rate: 142/100,000; CPAP/other sleep machines 95.3% vs auto-CPAP 4.7%) with also high intra-regional variation (56/100,000 in Mantova vs. 260/100,000 in Pavia). There were 21,826 patients on LTOT (prescription rate: 217/100,000 rate; liquid-O2 94%, O2-gas 2.08%, O2-concentrators 3.8%), with again high intra-regional variation (100/100,000 in Bergamo vs 410/100,000 in Valle Camonica). The crude rate of HMV prescriptions in Lombardy is very high, with a high intra-regional variability in prescribing HMV, LTOT and CPAP which is partly explainable by the accessibility to specialist centers with HMV/sleep-study facilities. Analysis of administrative data and variability mapping can help identify areas of reduced access for an improved standardization of services. An audit among Health Payer and prescribers to interpret the described huge variability could be welcomed.
很少有研究分析意大利家庭机械通气（HMV）的普及率和可及性。我们旨在调查伦巴第地区HMV以及长期氧疗（LTOT）和持续气道正压通气（CPAP）的普及率和处方差异。从2012年的计费数据中收集了伦巴第15个地方医疗保健区的HMV（包括无创和气管切开）、CPAP（自动CPAP、CPAP/其他睡眠机器）和LTOT（液氧、氧气、制氧机）的处方率，并进行比较。计算了粗率（每10万人）和不同医疗保健区的率。2012年，6325名患者接受HMV治疗（粗处方率：63/10万），各地区差异很大（米兰1区为8/10万，而帕维亚为150/10万）。有14237名患者接受CPAP治疗（粗处方率：142/10万；CPAP/其他睡眠机器占95.3%，自动CPAP占4.7%），区域内差异也很大（曼托瓦为56/10万，而帕维亚为260/10万）。有21826名患者接受LTOT治疗（处方率：217/10万；液氧占94%，氧气占2.08%，制氧机占3.8%），区域内差异同样很大（贝加莫为100/10万，而卡莫尼卡山谷为410/10万）。伦巴第地区HMV处方的粗率非常高，在HMV、LTOT和CPAP的处方方面存在很高的区域内差异，部分原因是拥有HMV/睡眠研究设施的专科中心的可及性。分析行政数据和差异映射有助于确定服务可及性降低的区域，以改善服务的标准化。欢迎对医疗支付方和开处方者进行审计，以解释所描述的巨大差异。
