Department of Pharmacology, Faculty of Pharmacy, Acibadem Mehmet Ali Aydinlar University, İstanbul, Turkey.
Department of Medical Pharmacology, International School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
Prim Health Care Res Dev. 2021 Dec 2;22:e78. doi: 10.1017/S1463423621000797.
The most frequently prescribed analgesic drugs in primary care centers in Turkey are diclofenac and paracetamol, respectively. In this study, we aimed to compare paracetamol-included prescriptions (PIP) and diclofenac-included prescriptions (DIP) generated for adult patients in primary care.
In this cross-sectional study, PIPs (n = 280 488) and DIPs (n = 337 935) created for adults by systematic sampling among primary care physicians working in Istanbul in 2016 (n = 1431) were examined. The demographic characteristics, diagnoses, and additional drugs in PIPs and DIPs were compared.
Women constituted the majority in both groups (69.8% and 67.9%, respectively; P < 0.05), and mean age at PIP (52.6 ± 18.8 years) was lower compared to DIP (56.3 ± 16.1 years), (P < 0.05). In single-diagnosis prescriptions, 11 of the 15 most common diagnoses in PIP were respiratory tract infections (47.9%); three pain-related diagnoses formed 4.6% of all these prescriptions. In DIP, the number of pain-related diagnoses, mostly of musculoskeletal origin, was eight (28.5%); four diagnoses (7.8%) were upper respiratory tract infections. While hypertension was the third most common diagnosis in PIP (6.1%), it was ranked first in DIP (8.0%). The percentage of prescriptions with additional analgesic (14.0% versus 18.3%, P < 0.001), proton-pump inhibitor (13.8% versus 18.4%; P < 0.001), and antihypertensive (22.0% versus 24.8%, P < 0.001) was lower in PIP compared to DIP. However, the percentage of prescriptions with antibiotics (31.3% versus 14.7%, P < 0.001) was higher in PIP.
Paracetamol appears to be preferred mostly in upper respiratory tract infections compared to the preference of diclofenac rather in painful/inflammatory musculoskeletal conditions. The presence of hypertension among the most commonly encountered diagnoses for these analgesic drugs points to challenges in establishing the diagnosing-treatment match and indicates potential irrational prescribing practice, especially for interactions.
在土耳其的基层医疗中心，最常开的止痛药分别是双氯芬酸和扑热息痛。本研究旨在比较基层医疗中开具的含扑热息痛处方（PIP）和含双氯芬酸处方（DIP）。
本横断面研究对 2016 年伊斯坦布尔系统抽样的 1431 名基层医疗医生开具的成人 PIP（n=280488）和 DIP（n=337935）进行了分析。比较了 PIP 和 DIP 中的人口统计学特征、诊断和附加药物。
两组中女性均占多数（分别为 69.8%和 67.9%；P<0.05），PIP 的平均年龄（52.6±18.8 岁）低于 DIP（56.3±16.1 岁）（P<0.05）。在单一诊断处方中，PIP 中最常见的 15 种诊断中的 11 种是呼吸道感染（47.9%）；3 种与疼痛相关的诊断占所有这些处方的 4.6%。在 DIP 中，与疼痛相关的诊断数量较多，主要来自肌肉骨骼，有 8 种（28.5%）；4 种诊断（7.8%）是上呼吸道感染。高血压是 PIP 中第三常见的诊断（6.1%），但在 DIP 中排名第一（8.0%）。PIP 中附加镇痛药（14.0%比 18.3%，P<0.001）、质子泵抑制剂（13.8%比 18.4%；P<0.001）和降压药（22.0%比 24.8%，P<0.001）的处方比例低于 DIP。然而，PIP 中抗生素的处方比例（31.3%比 14.7%，P<0.001）更高。
与双氯芬酸相比，扑热息痛在治疗上呼吸道感染方面似乎更受欢迎，而在治疗疼痛/炎症性肌肉骨骼疾病方面则更倾向于使用双氯芬酸。这两种镇痛药最常见的诊断中都有高血压，这表明在确定诊断-治疗匹配方面存在挑战，并表明存在潜在的不合理处方行为，尤其是在药物相互作用方面。
