CAJ | 학술논문

目的调查2006年我国帕金森病治疗指南的推出对帕金森病患者初始用药的影响,同时研究医院级别与医疗保险对帕金森病首次处方药物的影响. 方法通过对北京部分地区136例原发性帕金森病患者进行调查,将首次用药为左旋多巴制剂和多巴胺受体激动剂患者比例进行对比分析. 结果 136例患者中剔除起始用药既非左旋多巴制剂也非多巴胺受体激动剂的患者,首次用药年龄≥65岁患者61例,其中起始用药时间段为2006年以前(包括2006年)、2007 2009年、2010年之后(包括2010年)3个时间段首次用药为多巴胺受体激动剂和左旋多巴制剂的患者分别为1例和19例、1例和11例、5例和24例,患者比例差异无统计学意义(x2=1.891,P=0.388);而首次用药年龄＜65岁患者41例,3个时间段首次用药为多巴胺受体激动剂和左旋多巴制剂的患者分别为1例和23例、0例和10例、3例和4例,3个时间段左旋多巴制剂与多巴胺受体激动剂使用患者比例差异有统计学意义(x2=10.644,P=0.005),2010年之后起始用药为多巴胺受体激动剂患者比例较2006年以前明显升高(x2=7.219,P=0.028).三甲医院首次用药多巴胺受体激动剂使用率13.6％,非三甲医院使用率6.3％,不同级别医院的首次用药多巴胺受体激动剂使用率差异无统计学意义(x2=0.675,P=0.686);享有医保的患者首次服药为多巴胺受体激动剂比例为13.1％,无医保的患者为10.0％,差异无统计学意义(x2=0.141,P=0.000). 结论对年龄≥65岁的老年患者,指南推出前后左旋多巴制剂与多巴胺受体激动剂的起始用药比例无明显变化,而对＜65岁的患者,指南推出后激动剂的起始使用比例显著增加;未发现医院级别和医保类型对首次处方药物有明显影响.
목적 조사2006년아국파금삼병치료지남적추출대파금삼병환자초시용약적영향,동시연구의원급별여의료보험대파금삼병수차처방약물적영향. 방법 통과대북경부분지구136례원발성파금삼병환자진행조사,장수차용약위좌선다파제제화다파알수체격동제환자비례진행대비분석. 결과 136례환자중척제기시용약기비좌선다파제제야비다파알수체격동제적환자,수차용약년령≥65세환자61례,기중기시용약시간단위2006년이전(포괄2006년)、2007 2009년、2010년지후(포괄2010년)3개시간단수차용약위다파알수체격동제화좌선다파제제적환자분별위1례화19례、1례화11례、5례화24례,환자비례차이무통계학의의(x2=1.891,P=0.388);이수차용약년령＜65세환자41례,3개시간단수차용약위다파알수체격동제화좌선다파제제적환자분별위1례화23례、0례화10례、3례화4례,3개시간단좌선다파제제여다파알수체격동제사용환자비례차이유통계학의의(x2=10.644,P=0.005),2010년지후기시용약위다파알수체격동제환자비례교2006년이전명현승고(x2=7.219,P=0.028).삼갑의원수차용약다파알수체격동제사용솔13.6％,비삼갑의원사용솔6.3％,불동급별의원적수차용약다파알수체격동제사용솔차이무통계학의의(x2=0.675,P=0.686);향유의보적환자수차복약위다파알수체격동제비례위13.1％,무의보적환자위10.0％,차이무통계학의의(x2=0.141,P=0.000). 결론 대년령≥65세적노년환자,지남추출전후좌선다파제제여다파알수체격동제적기시용약비례무명현변화,이대＜65세적환자,지남추출후격동제적기시사용비례현저증가;미발현의원급별화의보류형대수차처방약물유명현영향.
Objective To evaluate the effect of Parkinson's disease treatment guideline on the initial medicine therapy and to explore the impact of hospital grade level and type of insurance on the initial prescription for Parkinson's disease.Methods We identified 136 PD patients as part of a population-based study in Beijing and made a comparison between the patients with initial prescriptions of dopamine receptor agonists (DA) and levodopa (LD).Results Among 136 patients,excluding patients without initial medication of levodopa or dopamine receptor agonist,there were 61 cases with initial drug administration aged ≥ 65 years.Among the 61 cases,1 cases and 19 cases administrated dopamine receptor agonist and levodopa respectively before 2006,1 case and 11 cases respectively from 2007 to 2009,and 5 cases and 24 cases respectively after 2010.There was no significant difference in the percentage between patients with initial administration of levodopa and dopamine receptor agonist in the three periods (x2 =1.891,P =0.388).In 41 patients with initial drug administration of dopamine receptor agonist or levodopa aged＜65 years,1 cases and 23 cases administrated dopamine receptor agonist or levodopa respectively before 2006,0 case and 10 cases respectively from 2007 to 2009,and 3 cases and 4 cases respectively after 2010.There was significant differences in the percentage between patients with initial administration of levodopa and dopamine receptor agonist in the three periods (x2 =10.644,P=0.005).The percentage of patients with initial administration of dopamine receptor agonist aged＜65 years was increased after 2010 as compared before 2006 (x2 =7.219,P=0.028).There were no significant differences in the percentage of patients with initial administration of dopamine receptor agonist between grade 3 and non-grade 3 hospitals (13.6％ vs.6.3％,x2=0.675,P=0.686)and between patients with and without insurance (13.1％ vs.10.0％,x2=0.141,P=1.000).Conclusions The percentage of patients with initial administration of levodopa and dopamine receptor agonist has no significant difference between patients with initial drug administration aged ≥ 65 years before and after the introduction of Parkinson's disease treatment guideline,while the percentage is increased in patients with initial drug administration aged＜65 years.No impact of hospital grade level and type of insurance on initial administration for Parkinson's disease is found.