台湾非甾体抗炎药与抗酸药共处方:国民保险理赔分析。

Tzeng-Ji Chen, Jui-Yao Liu, Shinn-Jang Hwang
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引用次数: 0

摘要

背景:抗酸药通常与非甾体抗炎药(NSAIDs)合用,尽管没有广泛的证据表明抗酸药在预防非甾体抗炎药相关胃病中的作用。我们对台湾门诊的国民保险理赔进行调查,以确定这种联合治疗在全国范围内的程度。方法:采用全国健康保险研究数据库提供的抽样数据进行分析。它们占1999年门诊医疗服务索赔总额的0.2%。对同一处方的非甾体抗炎药和抗酸药进行评估。NSAIDs的选择和分组遵循世界卫生组织推荐的解剖治疗化学(ATC)分类系统的指导方针。只考虑了定期就诊时处方的口服药物。结果:在425,442张处方中,非阿司匹林类非甾体抗炎药有108,818张(25.6%),抗酸药有235,252张(55.3%)。此外,抗酸药在含有非甾体抗炎药的处方中占71.3%,在不含非甾体抗炎药的处方中占49.8% (p < 0.001)。非甾体抗炎药与抗酸药在不同专科医师处方中均存在显著相关性,但非甾体抗炎药处方中抗酸药的共处方率最高的为神经外科的92.8%,最低的为儿科的49.8%。非甾体抗炎药与抗酸药在不同级别医疗机构的联合处方率分别为:医疗中心80.9%、地区医院83.5%、地方医院87.4%、基层医疗单位66.6%。与其他亚组相比,奥昔康亚组与抗酸药合用的频率更高(优势比= 1.51,p = 0.001)。结论:非阿斯匹灵类非甾体抗炎药与抗酸药同时服用在台湾地区确实是一种普遍的做法。除了缓解非甾体抗炎药相关的消化不良的作用外,抗酸药在预防非甾体抗炎药相关的消化性溃疡或掩盖这些溃疡的警告症状方面的作用还需要进一步的评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Non-steroidal anti-inflammatory drug and antacid co-prescription in Taiwan: analysis of national insurance claims.

Background: Antacids were usually co-prescribed with non-steroidal anti-inflammatory drugs (NSAIDs), although no broad evidences were available as to the effects of antacids in preventing NSAID-associated gastropathy. We performed a survey of national insurance claims for outpatient services in Taiwan to determine the extent of this co-therapy nationwide.

Methods: The National Health Insurance Research Database supplied the sampling datasets for analysis. They represented 0.2% of the entire claims for outpatient medical services in 1999. Co-prescribing was assessed as NSAIDs and antacids on the same prescription. The selection and grouping of NSAIDs followed the guidelines of the Anatomical Therapeutic Chemical (ATC) Classification System recommended by the World Health Organization. Only the oral drugs prescribed on regular visits were taken into account.

Results: In totally 425,442 prescriptions with 1,825,604 items of drugs, non-aspirin NSAIDs were present in 108,818 (25.6%) prescriptions and antacids in 235,252 (55.3%) prescriptions respectively. Furthermore, antacids were present in 71.3% of prescriptions that contained NSAIDs and in 49.8% of prescriptions that did not contain NSAIDs (p < 0.001). Significant association of NSAIDs and antacids existed in different specialties of prescribing physicians, but the co-prescription rate (antacids in NSAIDs prescriptions) varied from the highest of 92.8% in the neurosurgery to the lowest of 49.8% in the pediatrics. Significant association of NSAIDs and antacids also existed at different levels of health care facilities, where the co-prescription rates were 80.9% at medical centers, 83.5% at regional hospitals, 87.4% at local hospitals, and 66.6% at primary care units. The subgroup of oxicams was more frequently co-prescribed with antacids than other subgroups (odds ratio = 1.51, p = 0.001).

Conclusions: Concomitant prescription of oral non-aspirin NSAIDs and antacids was indeed a popular practice in Taiwan. Beside their effects in alleviating the NSAID-associated dyspepsia, the role of antacids in preventing NSAID-associated peptic ulcers or in masking the warning symptoms of these ulcers demands further evaluation.

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