全国代表性样本中抗帕金森药物使用的患病率及相关因素
Prevalence and Correlates of Anti-Parkinson Drug Use in a Nationally Representative Sample.
作者信息
Dahodwala Nabila, Willis Allison W, Li Pengxiang, Doshi Jalpa A
机构信息
Department of Neurology Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania USA.
Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia Pennsylvania USA.
出版信息
Mov Disord Clin Pract. 2016 Aug 22;4(3):335-341. doi: 10.1002/mdc3.12422. eCollection 2017 May-Jun.
BACKGROUND
Although numerous prescription drugs are available to treat Parkinson's disease (PD), little is known about national use in clinical practice and which factors may influence variability in care. The objectives of this study were to describe the prevalence of anti-Parkinson drug use among Medicare beneficiaries with PD and to identify demographic and clinical factors associated with drug use.
METHODS
This retrospective study was based on a random sample of annual 5% Medicare Part A and B claims linked with Medicare Part D drug files from 2007 through 2010. The study sample included fee-for-service Medicare beneficiaries with continuous stand-alone Part D enrollment who had been diagnosed with PD in the given year. First, any PD drug use and drug use by class (levodopa, dopamine agonist, anticholinerigc, monoamine oxidase B inhibitors, catechol-O-methyltransferase inhibitors, and amantadine) were described. Using generalized estimating equation regressions, patient and provider characteristics associated with anti-Parkinson drug use and choice were examined.
RESULTS
Over 81% of patients with PD were treated with anti-Parkinson drugs, and this proportion was stable over the 4 years of the study. The majority were treated with levodopa (90%); followed by dopamine agonists (29-31%); then monoamine oxidase B inhibitors, anticholinergics, amantadine, and catechol-O-methyltransferase inhibitors (all between 5% and 11%). Holding all else equal, patients who were not seen by a neurologist (odds ratio, 0.41; 95% confidence interval, 0.38-0.44; < 0.001) and African-American patients (odds ratio, 0.80; 95% confidence interval, 0.69-0.93; = 0.003) were significantly less likely to be treated.
CONCLUSIONS
Among a national sample of Medicare beneficiaries with PD, the majority received anti-Parkinson drugs. However, there was relative under-treatment of African-Americans and patients who were not seen by a neurologist for care.
背景
尽管有多种处方药可用于治疗帕金森病（PD），但对于其在临床实践中的全国使用情况以及哪些因素可能影响治疗差异知之甚少。本研究的目的是描述患有PD的医疗保险受益人中抗帕金森药物的使用情况，并确定与药物使用相关的人口统计学和临床因素。
方法
这项回顾性研究基于2007年至2010年每年5%的医疗保险A部分和B部分索赔的随机样本，这些索赔与医疗保险D部分的药物档案相关联。研究样本包括在给定年份被诊断患有PD的按服务收费的医疗保险受益人，他们连续单独参加了D部分保险。首先，描述了任何帕金森药物的使用情况以及按类别（左旋多巴、多巴胺激动剂、抗胆碱能药物、单胺氧化酶B抑制剂、儿茶酚-O-甲基转移酶抑制剂和金刚烷胺）的药物使用情况。使用广义估计方程回归分析，研究了与抗帕金森药物使用和选择相关的患者及医疗服务提供者特征。
结果
超过81%的PD患者接受了抗帕金森药物治疗，这一比例在研究的4年中保持稳定。大多数患者接受左旋多巴治疗（90%）；其次是多巴胺激动剂（29%-31%）；然后是单胺氧化酶B抑制剂、抗胆碱能药物、金刚烷胺和儿茶酚-O-甲基转移酶抑制剂（均在5%-11%之间）。在其他条件相同的情况下，未看过神经科医生的患者（比值比，0.41；95%置信区间，0.38-0.44；P<0.001）和非裔美国患者（比值比，0.80；95%置信区间，0.69-0.93；P=0.003）接受治疗的可能性显著较低。
结论
在全国患有PD的医疗保险受益人的样本中，大多数人接受了抗帕金森药物治疗。然而，非裔美国人和未看过神经科医生进行治疗的患者相对治疗不足。
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