Center for Public Health Research (CSISP-FISABIO), Valencia, Spain.
Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain.
PLoS One. 2018 Jun 21;13(6):e0199086. doi: 10.1371/journal.pone.0199086. eCollection 2018.
Little is known about the contextual variability in osteoporosis medication utilization. Our aims were 1) to describe variations in utilization and spending on osteoporotic medication between the Primary Care Health Zones (PHZ) of the Valencia region, Spain, 2) to analyze observed variations using Small Area Variation Analysis methods, and 3) to quantify the influence of the specialized care level on variations in utilization. We conducted a population-based cross-sectional ecological study of expenditure and utilization of five therapeutic groups marketed as osteoporosis treatments in Spain in 2009. The unit of analysis was the PHZ (in total 240) nested in the 23 Hospital Healthcare Departments (HHD) of the region of Valencia, covering a population of about 4.9 million inhabitants. Drug utilization was measured by dispensed Defined Daily Dose per 1000 women aged 50 years old and over and day (DID) per PHZ and cost was measured by the annual osteoporosis drug cost per woman aged 50 and older as well as the average price of DDD (Defined Daily Dose) in each PHZ. We calculated Indirect Standardized Drug Utilization Ratios (ISR) and we used Spearman's correlation to analyze associations between the ISRs of the different therapies. The average osteoporosis drug consumption was 119.1 DID, ranging from 77.6 to 171.3 DID (2.2 times higher) between PHZs in the 5th and 95th percentiles. Annual expenditure also showed a two-fold variation among PHZs. Average prices of the DDD by therapeutic group showed very low or no variation, although they differed substantially among therapeutic groups. Regarding the standardized consumption of osteoporotic drugs, HHDs explained a substantial part (39%) of the variance among PHZs. In conclusion, there is considerable variability in the volume and choice of anti-osteoporotic treatments between PHZs. with HHDs explaining an important proportion of the variation in utilization. Interventions aimed at reducing variation to improve appropriate care should take into account both the PHZ and HHD levels of care.
关于骨质疏松症药物使用的背景变异性知之甚少。我们的目的是：1）描述西班牙巴伦西亚地区初级保健卫生区（PHZ）之间骨质疏松症药物使用和支出的变化；2）使用小区域变异分析方法分析观察到的变异；3）量化专科护理水平对利用变化的影响。我们对 2009 年在西班牙销售的五种治疗组的药物支出和使用情况进行了基于人群的横断面生态研究。分析单位是嵌套在该地区 23 个医院医疗部门（HHD）中的 PHZ（共计 240 个），覆盖了约 490 万居民。药物利用度以每 1000 名 50 岁及以上女性的分配日剂量（DID）和每 PHZ 的每日剂量（DDD）表示，成本以每 50 岁及以上女性的年骨质疏松症药物成本以及每个 PHZ 的 DDD（日剂量）的平均价格表示。我们计算了间接标准化药物利用比（ISR），并使用 Spearman 相关分析来分析不同治疗方法的 ISR 之间的相关性。骨质疏松症药物的平均消耗量为 119.1 DID，5 至 95 百分位 PHZ 之间的 DID 范围为 77.6 至 171.3 DID（高 2 倍）。PHZ 之间的年度支出也存在两倍的差异。各治疗组的 DDD 平均价格差异很小或没有差异，尽管它们在治疗组之间差异很大。关于骨质疏松症药物的标准化使用，HHD 解释了 PHZ 之间变异性的很大一部分（39%）。总之，PHZ 之间抗骨质疏松药物的使用量和选择存在相当大的差异。HHD 解释了利用变化的重要部分。旨在减少差异以改善适当护理的干预措施应同时考虑 PHZ 和 HHD 护理水平。
