Department of Scientific Affairs, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Chesapeake Biological Laboratory, University of Maryland Center for Environmental Science, Solomons, Maryland, USA.
BMJ Open. 2024 Sep 25;14(9):e081628. doi: 10.1136/bmjopen-2023-081628.
This study was conducted to examine urban-rural differences in the real-world prescribing pattern of oral anticoagulants and geographic variations in the prescribing pattern among clinicians serving Medicare beneficiaries in the USA.
A cross-sectional study.
A real-world setting.
232 665 clinicians who prescribed oral anticoagulants for Medicare beneficiaries from the 2020 Medicare Provider Utilisation and Payment Data were classified as warfarin only, direct oral anticoagulants (DOACs) only or warfarin+DOAC prescribers.
Urban-rural differences in the prescribing patterns were examined using multivariate multinominal logistic regression analysis. A geospatial analysis was conducted to estimate standardised prescriber ratios (SPR) for DOAC only or warfarin only prescribers versus warfarin+DOAC prescribers to illustrate hot and cold spots for DOAC adoption in the USA.
92% of clinicians who prescribed oral anticoagulants prescribed DOAC in 2020. Clinicians from rural regions were more likely to prescribe warfarin only (adjusted OR=1.335, 95% CI=(1.281 to 1.391)) and DOAC only (adjusted OR=2.052, 95% CI=(1.999 to 2.106)), compared with clinicians from urban regions. Hot spots for SPR of DOAC only versus warfarin+DOAC prescribers were mostly found in California, southern and southeastern states; cold spots were mostly found in Minnesota and Iowa. Hot spots for SPR of warfarin only versus warfarin+DOAC prescribers were mostly found in several metropolitan areas on the west coast and in Midwest; cold spots were mostly found on the east coast.
Urban-rural status of clinicians was associated with their prescribing patterns of oral anticoagulants. The study identifies geographical heterogeneity in DOAC adoption and highlights gaps that may need to be addressed for increased accessibility of DOAC for patients in need.
本研究旨在考察美国农村和城市地区在真实世界中口服抗凝剂处方模式的差异，以及为医疗保险受益人开处方的临床医生之间的处方模式的地理差异。
横断面研究。
真实世界的环境。
2020 年医疗保险提供者利用和支付数据中为医疗保险受益人开口服抗凝剂的 232665 名临床医生，分为仅开华法林、仅开直接口服抗凝剂（DOAC）或同时开华法林和 DOAC 的临床医生。
采用多变量多项逻辑回归分析，考察处方模式的城乡差异。进行地理空间分析，以估计仅开 DOAC 或仅开华法林的临床医生相对于同时开华法林和 DOAC 的标准开方医生比值（SPR），以说明美国 DOAC 采用的热点和冷点。
2020 年，92%开口服抗凝剂的临床医生开 DOAC。与城市地区的临床医生相比，来自农村地区的临床医生更有可能只开华法林（调整后的 OR=1.335，95%CI=（1.281 至 1.391））和仅开 DOAC（调整后的 OR=2.052，95%CI=（1.999 至 2.106））。SPR 为仅开 DOAC 与同时开华法林和 DOAC 的临床医生的热点主要集中在加利福尼亚州、南部和东南部各州；冷点主要集中在明尼苏达州和爱荷华州。SPR 为仅开华法林与同时开华法林和 DOAC 的临床医生的热点主要集中在西海岸和中西部的几个大都市区；冷点主要集中在东海岸。
临床医生的城乡状况与其口服抗凝剂的处方模式有关。该研究确定了 DOAC 采用的地理异质性，并强调了可能需要解决的差距，以增加有需要的患者获得 DOAC 的可及性。
