Department of Urology, University of Michigan Medical School, Ann Arbor, Michigan.
Veterans Affairs Health Services Research & Development, Center for Clinical Management and Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
Urol Pract. 2023 May;10(3):230-235. doi: 10.1097/UPJ.0000000000000390. Epub 2023 Jan 30.
We examine changes in the volume of patients with advanced prostate cancer and prescriptions for abiraterone and enzalutamide among urology practices with and without in-office dispensing.
Using data from the National Council for Prescription Drug Programs, we identified in-office dispensing by single-specialty urology practices from 2011 to 2018. As the greatest growth in implementing dispensing occurred among large groups in 2015, outcomes were measured at the practice level in 2014 (before) and 2016 (after) for dispensing and non-dispensing practices. Outcomes included the volume of men with advanced prostate cancer managed by a practice and prescriptions for abiraterone and/or enzalutamide. Using national Medicare data, generalized linear mixed models were fit to compare the practice-level ratio of each outcome (2016 relative to 2014) adjusting for regional contextual factors.
In-office dispensing increased from 1% to 30% of single-specialty urology practices from 2011 to 2018, with 28 practices implementing dispensing in 2015. In 2016 compared to 2014, adjusted changes in the volume of patients with advanced prostate cancer managed by a practice were similar between non-dispensing (0.88, 95% CI 0.81-0.94) and dispensing (0.93, 95% CI 0.76-1.09) practices ( = .60). Prescriptions for abiraterone and/or enzalutamide increased in both non-dispensing (2.00, 95% CI 1.58-2.41) and dispensing (8.99, 95% CI 4.51-13.47) practices ( < .01).
In-office dispensing is increasingly common in urology practices. This emerging model is not associated with changes in patient volume but is associated with increased prescriptions for abiraterone and enzalutamide.
我们考察了在设有和不设门诊配药的泌尿外科诊所中，晚期前列腺癌患者数量以及开具阿比特龙和恩扎卢胺处方的变化。
利用国家处方药物计划委员会的数据，我们从 2011 年至 2018 年确定了单专科泌尿外科诊所的门诊配药情况。由于 2015 年大型团体在实施配药方面的增长最大，因此在 2014 年（实施前）和 2016 年（实施后）对设有和不设门诊配药的诊所进行了实践水平的测量。结果包括诊所管理的晚期前列腺癌患者数量以及阿比特龙和/或恩扎卢胺的处方数量。利用国家医疗保险数据，使用广义线性混合模型，在调整区域背景因素的情况下，比较了每个结果（2016 年相对于 2014 年）的实践水平比率。
2011 年至 2018 年，单专科泌尿外科诊所的门诊配药比例从 1%增加到 30%，其中 28 家诊所于 2015 年实施配药。与 2014 年相比，2016 年不设门诊配药（0.88，95%CI 0.81-0.94）和设门诊配药（0.93，95%CI 0.76-1.09）实践中管理的晚期前列腺癌患者数量的调整变化相似（ =.60）。阿比特龙和/或恩扎卢胺的处方在不设门诊配药（2.00，95%CI 1.58-2.41）和设门诊配药（8.99，95%CI 4.51-13.47）实践中均增加（ <.01）。
在泌尿外科诊所中，门诊配药越来越普遍。这种新兴模式与患者数量的变化无关，但与阿比特龙和恩扎卢胺的处方增加有关。
