Chung-Ang University, Seoul, Republic of Korea.
Andong National University, Andong-si, Republic of Korea.
Arthritis Care Res (Hoboken). 2020 Oct;72(10):1374-1382. doi: 10.1002/acr.24054.
Since January 2013, a nationwide drug utilization review (DUR) system for therapeutic duplication (TD) of nonsteroidal antiinflammatory drugs (NSAIDs) has been implemented in Korea. Our objective was to perform an interrupted time series study to assess changes in the pattern of NSAIDs use in knee osteoarthritis patients after implementation of the regulations.
We compared the prescribing patterns in 2012 and 2013 by means of an interrupted time series study, using the Health Insurance Review and Assessment Service database. TD was defined as use of concurrent NSAIDs either on the same or on different prescriptions for >3 days in a patient. Level change and trend change (with 95% confidence intervals [95% CIs]), and absolute and relative changes in the proportion of TDs, were estimated using segmented regression models. Multivariable logistic regression models were used to explore patient and provider characteristics associated with the TDs.
Approximately 2.5 million patients were prescribed NSAIDs in both 2012 and 2013. The proportion of TDs before and after introduction of the DUR system was 7.4% and 5.6%, respectively. Overall, an absolute reduction of 89% and a relative reduction of 30% in TDs were observed. In the postregulation period, older patients, medical aid subscribers (odds ratio [OR] 1.87 [95% CI 1.84, 1.90]), and veterans (OR 3.28 [95% CI 3.10, 3.46]) were most likely to receive NSAID TDs.
The prescription of NSAID TDs decreased with the introduction of the nationwide DUR system. Continuous adherence to the DUR regulations and safety monitoring are needed, especially with the elderly, medical aid subscribers, and veterans.
自 2013 年 1 月起，韩国在全国范围内实施了一种药物利用审查（DUR）系统，以审查非甾体抗炎药（NSAIDs）的治疗性重复用药（TD）情况。我们的目的是通过一项中断时间序列研究来评估这些规定实施后膝骨关节炎患者 NSAIDs 使用模式的变化。
我们利用健康保险审查与评估服务数据库，通过中断时间序列研究比较了 2012 年和 2013 年的处方模式。TD 被定义为患者在同一张或不同处方上连续使用 NSAIDs 超过 3 天。使用分段回归模型估计了水平变化和趋势变化（95%置信区间[95%CI]），以及 TD 比例的绝对和相对变化。多变量逻辑回归模型用于探讨与 TD 相关的患者和提供者特征。
约有 250 万名患者在 2012 年和 2013 年均开具了 NSAIDs。引入 DUR 系统前后 TD 的比例分别为 7.4%和 5.6%。总体而言，TD 的绝对减少了 89%，相对减少了 30%。在监管后时期，老年患者、医疗补助受助人（比值比[OR]为 1.87[95%CI 为 1.84, 1.90]）和退伍军人（OR 为 3.28[95%CI 为 3.10, 3.46]）最有可能接受 NSAID TD 治疗。
随着全国性 DUR 系统的引入，NSAID TD 的处方量有所减少。需要持续遵守 DUR 规定并进行安全性监测，特别是针对老年人、医疗补助受助人以及退伍军人。
