坚持以循证医学为基础的指导方针制定非甾体类抗炎药处方的全国性状况

作     者：Abraham N.S El-Serag H.B Johnson M.L. 陈云茹 

作者机构：Michael E. DeBakey Veterans Affairs Medical Center 2002 Holcombe Boulevard (152) Houston TX 77030 United StatesDr. 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第4期

页      面：20-20页

学科分类：1002[医学-临床医学] 1009[医学-特种医学] 10[医学] 

主　　题：NSAID 指导方针 消化性溃疡 研究人群 抗凝剂 环氧化酶抑制剂 保护药 横断面研究 上消化道 日 

摘      要：Background &Aims: Our objective was to assess adherence to evidence-based guidelines by providers of the Department of Veterans Affairs nationwide. Methods: This was a cross-sectional study among veterans prescribed a nonsteroidal anti-inflammatory drug (NSAID) from January 1, 2002, to December 31, 2002. Prescrip tion data were linked to inpatient and outpatient medical records and death file s. The population was characterized as high risk based on the following: age 65 years or older, concurrent corticosteroid or anticoagulant use, history of pepti c ulcer, and high average daily dose of NSAIDs. Adherence was defined as the pre scription of a traditional NSAID with gastroprotection or a coxib in high-risk NSAID users. Univariate and multivariate analyses assessed the potential predict ors of adherence. Results: Three hundred three thousand seven hundred eighty-se ven met our definition of high risk. Most (97.3%) were male; 55.6%were white, 9.6%black, and 34.8%of other/unknown race. Age 65 years or older was the large st high-risk subset (87.1%). Overall, only 27.2%of highrisk veterans (n = 82, 766) were prescribed an adherent strategy. Among veterans with at least 2 risk f actors, adherence was 39.7%; among those with 3 risk factors, adherence was 41. 8%. Predictors of adherence included history of upper gastrointestinal events, anticoagulant use, rheumatologic disease, high Deyo comorbidity index score, use of low-dose salicylates, and concurrent corticosteroid use. Predictors of nona dherence included prescriptions≥90 days and high average daily dose of NSAIDs. Conclusions: Adherence to evidence-based guidelines for safe prescription of NS AIDs in the Department of Veterans Affairs is low (27.2%). The likelihood of ad herence is further decreased if veterans are prescribed NSAIDs for ≥90 days.