Arabkhazaeli Ali, Vijverberg Susanne J H, van der Lee Maaike, van der Ent Cornelis K, Bruijnzeel-Koomen Carla A, de Bruin-Weller Marjolein S, Raaijmakers Jan A, Maitland-van der Zee Anke H
Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Pediatr Dermatol. 2018 May;35(3):378-383. doi: 10.1111/pde.13455. Epub 2018 Mar 24.
To study topical corticosteroid use in Dutch asthmatic children using pharmacy dispensing data and to assess whether Dutch physicians prescribe topical corticosteroids in this population according to clinical guidelines.
Medication histories of children using asthma medication were extracted from the pharmacy dispensing system in 100 Dutch community pharmacies. The incidence rate and the potency of topical corticosteroid prescriptions per age were assessed. The topical corticosteroid incidence rates of the different age groups were compared using the Pearson chi-square test. Generalized linear models were used to study the prescription behavior of general practitioners and atopic dermatitis-related specialists regarding different classes of topical corticosteroids.
Thirty percent of the infants received a topical corticosteroid prescription, compared with 15%-18% of the children aged 4 and older. Similarly, the mean number of topical corticosteroid prescriptions in infants was 2.2 per year, compared with 1.6-1.9 in children aged 4 and older. In concordance with the clinical guidelines, we observed that atopic dermatitis-related specialists more often prescribed first prescriptions of potent and very potent topical corticosteroids than general practitioners (relative risk = 2.55, 95% confidence interval = 1.79-3.63). Statistically significant differences (P < .01) were found between potencies of prescribed topical corticosteroids.
Younger children receive more topical corticosteroid prescriptions than children aged 4 and older, and there is a statistically significantly higher prescription rate of topical corticosteroid for infants. Sometimes general practitioners do not follow guidelines and prescribe more-potent topical corticosteroids without a prior prescription of the same potency by a specialist.
利用药房配药数据研究荷兰哮喘儿童局部用皮质类固醇的使用情况，并评估荷兰医生在该人群中是否根据临床指南开具局部用皮质类固醇。
从100家荷兰社区药房的药房配药系统中提取使用哮喘药物儿童的用药史。评估各年龄段局部用皮质类固醇处方的发生率和效力。使用Pearson卡方检验比较不同年龄组的局部用皮质类固醇发生率。采用广义线性模型研究全科医生和特应性皮炎相关专科医生关于不同类别局部用皮质类固醇的处方行为。
30%的婴儿接受了局部用皮质类固醇处方，而4岁及以上儿童的这一比例为15%-18%。同样，婴儿每年局部用皮质类固醇处方的平均数量为2.2张，而4岁及以上儿童为1.6-1.9张。与临床指南一致，我们观察到特应性皮炎相关专科医生比全科医生更常开具强效和超强效局部用皮质类固醇的首次处方（相对风险=2.55，95%置信区间=1.79-3.63）。在开具的局部用皮质类固醇效力之间发现了具有统计学意义的差异（P<.01）。
年幼儿童比4岁及以上儿童接受更多的局部用皮质类固醇处方，婴儿局部用皮质类固醇的处方率在统计学上显著更高。有时全科医生不遵循指南，在没有专科医生预先开具相同效力处方的情况下开具更强效的局部用皮质类固醇。
