慢性疾病患者中不相关疾病的治疗。

The treatment of unrelated disorders in patients with chronic medical diseases.

作者信息

Redelmeier D A, Tan S H, Booth G L

机构信息

Department of Medicine, University of Toronto, Sunnybrook Health Science Centre, ON, Canada.

出版信息

N Engl J Med. 1998 May 21;338(21):1516-20. doi: 10.1056/NEJM199805213382106.

DOI:10.1056/NEJM199805213382106

PMID:9593791

Abstract

BACKGROUND

Patients can have several illnesses concurrently, yet some of these diseases may be neglected if one problem consumes attention. We conducted a population-based analysis in Ontario, Canada - where universal health insurance is provided - to determine whether unrelated disorders are less likely to be treated in patients with chronic diseases.

METHODS

We studied the 1,344,145 residents of Ontario in 1995 who were 65 or older and eligible to receive prescription medications free of charge as part of the Ontario Drug Benefit program. Patients with diabetes mellitus were identified by prescriptions for insulin, pulmonary emphysema by prescriptions for ipratropium bromide, and psychotic syndromes by prescriptions for haloperidol. For each chronic disease, we selected an unrelated treatment: estrogen-replacement therapy for patients with diabetes mellitus, lipid-lowering medications for those with pulmonary emphysema, and medical treatment of arthritis for those with psychotic syndromes.

RESULTS

The 30,669 patients with diabetes mellitus were less likely to receive estrogen-replacement therapy than the other subjects in the study (2.4 percent vs. 5.9 percent, P<0.001). The disease was associated with a 60 percent reduction in the odds of estrogen treatment (odds ratio, 0.40; 95 percent confidence interval, 0.37 to 0.43). Findings were similar for the 56,779 patients with pulmonary emphysema, who were less likely to receive lipid-lowering medications (odds ratio, 0.69; 95 percent confidence interval, 0.67 to 0.72; P<0.001), and the 17,336 patients with psychotic syndromes, who were less likely to receive medical treatments for arthritis (odds ratio, 0.59; 95 percent confidence interval, 0.57 to 0.62; P<0.001).

CONCLUSIONS

In patients 65 or older who have chronic medical diseases and who receive prescription medications free of charge, unrelated disorders are undertreated. Clinicians caring for patients with chronic diseases should remain alert to other disorders and minimize the number of missed opportunities for treating them.

摘要

背景

患者可能同时患有多种疾病，但如果其中一个问题吸引了全部注意力，那么某些疾病可能会被忽视。我们在加拿大安大略省进行了一项基于人群的分析（该省提供全民健康保险），以确定慢性病患者中不相关疾病接受治疗的可能性是否较低。

方法

我们研究了1995年安大略省1344145名65岁及以上且有资格作为安大略省药物福利计划一部分免费获得处方药的居民。通过胰岛素处方确定糖尿病患者，通过异丙托溴铵处方确定肺气肿患者，通过氟哌啶醇处方确定精神综合征患者。对于每种慢性病，我们选择一种不相关的治疗方法：糖尿病患者采用雌激素替代疗法，肺气肿患者采用降脂药物，精神综合征患者采用关节炎药物治疗。

结果

30669名糖尿病患者接受雌激素替代疗法的可能性低于研究中的其他受试者（2.4%对5.9%，P<0.001）。该疾病与雌激素治疗几率降低60%相关（优势比，0.40；95%置信区间，0.37至0.43）。56779名肺气肿患者的情况类似，他们接受降脂药物的可能性较小（优势比，0.69；95%置信区间，0.67至0.72；P<0.001），17336名精神综合征患者接受关节炎药物治疗的可能性也较小（优势比，0.59；95%置信区间，0.57至0.62；P<0.001）。