Alcohol, Drugs and Addictions Unit, National Institute for Health and Welfare, Helsinki, Finland; Division of Population Medicine, Cardiff University, Cardiff, United Kingdom.
Population Research Unit, University of Helsinki, Finland; Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, Sweden; The Max Planck Institute for Demographic Research, Rostock, Germany.
Drug Alcohol Depend. 2018 May 1;186:175-181. doi: 10.1016/j.drugalcdep.2018.02.008. Epub 2018 Mar 23.
Physician's intention to prescribe drugs could potentially be used to improve targeting of alcohol interventions and enhanced disease management to patients with a high risk of severe alcohol-related harm within outpatient settings.
Comparison of ten-year incidence trajectories of 13.8 million reimbursed purchases of prescription drugs among 303,057 Finnish men and women of whom 7490 ultimately died due to alcohol-related causes (Alc+), 14,954 died without alcohol involvement (Alc-), and 280,613 survived until the end of 2007.
5-10 years before death, 88% of the persons with an Alc+ death had received prescription medication, and over two-thirds (69%) had at least one reimbursed purchase of drugs for the alimentary tract and metabolism, the cardiovascular system, or the nervous system. Among persons with an Alc+ death, the incidence rate (IR) for purchases of hypnotics, and sedatives was 1.38 times higher (95% confidence interval (CI):1.32,1.44) compared to those with an Alc- death, and 4.07 times higher (95%CI:3.92,4.22) compared to survivors; and the IR for purchases of anxiolytics was 1.40 times higher (95%CI:1.34,1.47) compared to those with an Alc- death, and 3.61 times higher (95%CI:3.48,3.78) compared to survivors.
Using physician's intention to prescribe drugs affecting the alimentary tract and metabolism, cardiovascular system and nervous system could potentially be used to flag patients who might benefit from screening, targeted interventions or enhanced disease management. In particular, patients who are to be prescribed anxiolytics, hypnotics, and sedatives, and antidepressants may benefit from enhanced interventions targeted to problem drinking.
医生开处方的意愿可能被用来改善门诊环境中高风险严重酒精相关伤害患者的酒精干预措施和疾病管理的针对性。
比较了 303057 名芬兰男女患者 1380 万份处方药报销购买的十年发生率轨迹，其中 7490 人最终因酒精相关原因（Alc+）死亡，14954 人死亡与酒精无关（Alc-），280613 人存活至 2007 年底。
在死亡前 5-10 年，88%的 Alc+死亡者接受了处方药物治疗，超过三分之二（69%）至少有一次报销了用于胃肠道和代谢、心血管系统或神经系统的药物。在 Alc+死亡者中，催眠药和镇静剂的购买发生率（IR）比 Alc-死亡者高 1.38 倍（95%置信区间（CI）：1.32，1.44），比存活者高 4.07 倍（95%CI：3.92，4.22）；而安定的购买 IR 比 Alc-死亡者高 1.40 倍（95%CI：1.34，1.47），比存活者高 3.61 倍（95%CI：3.48，3.78）。
利用医生开具影响胃肠道和代谢、心血管系统和神经系统的药物的意愿，可以潜在地发现可能受益于筛查、针对性干预或强化疾病管理的患者。特别是那些被开处方安定、催眠药和镇静剂以及抗抑郁药的患者可能会从针对酗酒问题的强化干预中受益。
