Chair of Health Economics, Technical University of Munich, Munich, Germany
Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Pettenkofer School of Public Health, Munich, Germany.
BMJ Open. 2024 Sep 17;14(9):e080348. doi: 10.1136/bmjopen-2023-080348.
Evidence of geographical variation in total hip replacement (THR) and deviations from treatment guidelines persists. In this exploratory study, we aim to gain an in-depth understanding of patients' healthcare trajectories by identifying and visualising medication use patterns in coxarthrosis patients before surgery. We examine their association with patient characteristics and THR, and compare them with recommendations on mild analgesics, opioid prescription and exhaustion of conservative therapy.
In this exploratory study, we apply State Sequence Analysis (SSA) on German health insurance data (2012-2015). We analyse a cohort of coxarthrosis patients, half of whom underwent THR after a 1 year observation period and half of whom did not undergo surgery until at least 1 year after the observation period. Hierarchical states are defined based on prescriptions. We construct sequences, calculate sequence similarity using optimal matching and identify medication use patterns via clustering. Patterns are visualised, descriptive statistics are presented and logistic regression is employed to investigate the association of medication patterns with subsequent THR.
Seven distinct medication use patterns are identified, correlating strongly with patient characteristics and subsequent THR. Two patterns leading to THR demonstrate exhaustion of pharmacological therapy. Opioid use is concentrated in two small patterns with low odds for THR. The most frequent pattern lacks significant pharmacological therapy.
This SSA uncovers heterogeneity in medication use patterns before surgery in coxarthrosis patients. Cautious opioid handling and adherence to a stepped prescription approach are observed, but many patients display low medication therapy usage and lack evidence of exhausting conservative options before surgery.
全髋关节置换术（THR）的地域差异和治疗指南的偏差仍有证据。在这项探索性研究中，我们旨在通过识别和可视化术前髋关节骨关节炎患者的药物使用模式，深入了解患者的医疗轨迹。我们研究了这些模式与患者特征和 THR 的关联，并将其与轻度镇痛药、阿片类药物处方和保守治疗用尽的建议进行了比较。
在这项探索性研究中，我们应用状态序列分析（SSA）对德国健康保险数据（2012-2015 年）进行分析。我们分析了一组髋关节骨关节炎患者，其中一半在观察期后 1 年内接受 THR，另一半在观察期后至少 1 年内才接受手术。根据处方定义分层状态。我们构建序列，使用最佳匹配计算序列相似性，并通过聚类识别药物使用模式。对模式进行可视化，呈现描述性统计数据，并使用逻辑回归调查药物模式与随后的 THR 之间的关联。
确定了七种不同的药物使用模式，这些模式与患者特征和随后的 THR 密切相关。两种导致 THR 的模式表明药物治疗已用尽。阿片类药物的使用集中在两个小模式中，接受 THR 的可能性较低。最常见的模式没有明显的药物治疗。
这项 SSA 揭示了髋关节骨关节炎患者术前药物使用模式的异质性。谨慎使用阿片类药物和遵守逐步处方方法是观察到的，但许多患者表现出低药物治疗使用率，并且在手术前缺乏用尽保守治疗选择的证据。
