{"title":"评论:消化性溃疡h2受体拮抗剂治疗。","authors":"A Kinniry, L Antell, A S Murabito","doi":"10.1177/106002808802200929","DOIUrl":null,"url":null,"abstract":"times; 7.5 percent switched three or more times. Generally, the mean number of tablets prescribed per day correlated with the recommended dosing schedules of each of the products. The two qid products, ibuprofen and tolmetin 200 mg, were prescribed at an average of 3.4 and 3.9 tablets per day, respectively. Naproxen sodium, indomethacin, and fenoprofen, according to their labeling, may be prescribed either-qidor tid, and were prescribed at an average of 3.6,3.0, and 3.1 tablets pet day, respectively. Tolmetin 400 rng, with tid dosing recommended, was written at an average of 2.9 tablets per day. The bid products, sulindac and naproxen, were written at an average of 2.1 and 2.5 tablets per day, respectively. Of prescriptions written for sustained-release indomethacin, 60.5 percent were written at one capsule per day, as were 94.9 percent of piroxicam prescriptions. We examined the relationship among patient demographics, diagnosis, and compliance rate. Patients <:50 years of age were found to be more compliant with their medication than were younger patients (mean compliance rate = 0.69 vs. 0.59, p <0.001). Males were found to be more compliant than females (0.71 vs. 0.65, p<O.OOI), and whites more compliant than nonwhites (0.72 vs. 0.65, p<O.OOI). Patients with RA were more compliant than other arthritis patients (0.71 versus 0.65, p<O.OOI). Refilled prescriptions were stratified by prescribed dosage. Compliance with qd dosing was greater than that of any other schedule. The mean compliance rate for refilled qd prescriptions was 0.78. By contrast, the mean compliance rates for the other dosing schedules decreased consistently: bid 0.72; tid 0.64; qid 0.60; more than qid 0.44. We also examined the rate at which patients achieved selected levels of compliance: 65 percent of qd-prescribed patients consumed three-quarters of the prescribed dosage, compared with 55 percent of bid patients, 44 percent of tid patients, and only 37 percent of qid patients. The overall trend is toward greater compliance with less frequent dosing (all differences, p<O.OOl). Compliance was measured here as the percentage of prescribed amount consumed by the patient per day. A patient will seem compliant if he or she was prescribed 2 tablets per day and consumed 4 one day and none the next. There is no reason to believe, however, that such activity would bias the study results in one direction or another. Using these Medicaid claims data, patient compliance in a real-world setting may be examined. The patients studied did not have their pills counted, nor were they interviewed concerning compliance with medication. In short, the testing bias so often associated with studies of patient compliance has been avoided. At issue in this study is patient behavior vis-a-vis dosing instruction. Whether the physician is concerned with achieving analgesia or maximum antiinflammatory effect, disease management may best be achieved when patients take medication as prescribed. When a compliant patient returns to the physician with a report of toxicity or lack of efficacy, appropriate action can be taken. Noncompliant patients who return with a report of poor efficacy but who do not report noncompliance may find themselves prescribed an alternative agent, and will then experience the toxicity risk of the newly prescribed agent. The data presented above indicate that a strong relationship exists between increased dosing schedule and lower consumption of NSAlD. If one takes the position that consumption of less than onehalf of the prescribed amount constitutes therapeutically significant noncompliance, then the chance of this event can be halved, from nearly 4 in 10 with qid therapy to only 2 in 10 with qd therapy. When underconsumption of a prescribed NSAlD is in question, therefore, the possibility of using dosing schedule to minimize the problem should be considered.","PeriodicalId":77709,"journal":{"name":"Drug intelligence & clinical pharmacy","volume":"22 9","pages":"728-30"},"PeriodicalIF":0.0000,"publicationDate":"1988-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/106002808802200929","citationCount":"0","resultStr":"{\"title\":\"Comment: peptic ulcer H2-receptor antagonist therapy.\",\"authors\":\"A Kinniry, L Antell, A S Murabito\",\"doi\":\"10.1177/106002808802200929\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"times; 7.5 percent switched three or more times. Generally, the mean number of tablets prescribed per day correlated with the recommended dosing schedules of each of the products. The two qid products, ibuprofen and tolmetin 200 mg, were prescribed at an average of 3.4 and 3.9 tablets per day, respectively. Naproxen sodium, indomethacin, and fenoprofen, according to their labeling, may be prescribed either-qidor tid, and were prescribed at an average of 3.6,3.0, and 3.1 tablets pet day, respectively. Tolmetin 400 rng, with tid dosing recommended, was written at an average of 2.9 tablets per day. The bid products, sulindac and naproxen, were written at an average of 2.1 and 2.5 tablets per day, respectively. Of prescriptions written for sustained-release indomethacin, 60.5 percent were written at one capsule per day, as were 94.9 percent of piroxicam prescriptions. We examined the relationship among patient demographics, diagnosis, and compliance rate. Patients <:50 years of age were found to be more compliant with their medication than were younger patients (mean compliance rate = 0.69 vs. 0.59, p <0.001). Males were found to be more compliant than females (0.71 vs. 0.65, p<O.OOI), and whites more compliant than nonwhites (0.72 vs. 0.65, p<O.OOI). Patients with RA were more compliant than other arthritis patients (0.71 versus 0.65, p<O.OOI). Refilled prescriptions were stratified by prescribed dosage. Compliance with qd dosing was greater than that of any other schedule. The mean compliance rate for refilled qd prescriptions was 0.78. By contrast, the mean compliance rates for the other dosing schedules decreased consistently: bid 0.72; tid 0.64; qid 0.60; more than qid 0.44. We also examined the rate at which patients achieved selected levels of compliance: 65 percent of qd-prescribed patients consumed three-quarters of the prescribed dosage, compared with 55 percent of bid patients, 44 percent of tid patients, and only 37 percent of qid patients. The overall trend is toward greater compliance with less frequent dosing (all differences, p<O.OOl). Compliance was measured here as the percentage of prescribed amount consumed by the patient per day. A patient will seem compliant if he or she was prescribed 2 tablets per day and consumed 4 one day and none the next. There is no reason to believe, however, that such activity would bias the study results in one direction or another. Using these Medicaid claims data, patient compliance in a real-world setting may be examined. The patients studied did not have their pills counted, nor were they interviewed concerning compliance with medication. In short, the testing bias so often associated with studies of patient compliance has been avoided. At issue in this study is patient behavior vis-a-vis dosing instruction. Whether the physician is concerned with achieving analgesia or maximum antiinflammatory effect, disease management may best be achieved when patients take medication as prescribed. When a compliant patient returns to the physician with a report of toxicity or lack of efficacy, appropriate action can be taken. Noncompliant patients who return with a report of poor efficacy but who do not report noncompliance may find themselves prescribed an alternative agent, and will then experience the toxicity risk of the newly prescribed agent. The data presented above indicate that a strong relationship exists between increased dosing schedule and lower consumption of NSAlD. If one takes the position that consumption of less than onehalf of the prescribed amount constitutes therapeutically significant noncompliance, then the chance of this event can be halved, from nearly 4 in 10 with qid therapy to only 2 in 10 with qd therapy. When underconsumption of a prescribed NSAlD is in question, therefore, the possibility of using dosing schedule to minimize the problem should be considered.\",\"PeriodicalId\":77709,\"journal\":{\"name\":\"Drug intelligence & clinical pharmacy\",\"volume\":\"22 9\",\"pages\":\"728-30\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"1988-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://sci-hub-pdf.com/10.1177/106002808802200929\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Drug intelligence & clinical pharmacy\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/106002808802200929\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Drug intelligence & clinical pharmacy","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/106002808802200929","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
times; 7.5 percent switched three or more times. Generally, the mean number of tablets prescribed per day correlated with the recommended dosing schedules of each of the products. The two qid products, ibuprofen and tolmetin 200 mg, were prescribed at an average of 3.4 and 3.9 tablets per day, respectively. Naproxen sodium, indomethacin, and fenoprofen, according to their labeling, may be prescribed either-qidor tid, and were prescribed at an average of 3.6,3.0, and 3.1 tablets pet day, respectively. Tolmetin 400 rng, with tid dosing recommended, was written at an average of 2.9 tablets per day. The bid products, sulindac and naproxen, were written at an average of 2.1 and 2.5 tablets per day, respectively. Of prescriptions written for sustained-release indomethacin, 60.5 percent were written at one capsule per day, as were 94.9 percent of piroxicam prescriptions. We examined the relationship among patient demographics, diagnosis, and compliance rate. Patients <:50 years of age were found to be more compliant with their medication than were younger patients (mean compliance rate = 0.69 vs. 0.59, p <0.001). Males were found to be more compliant than females (0.71 vs. 0.65, p
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