在综合医疗保健系统中减少过度使用质子抑制剂的大规模多组件干预措施的影响:差异差异研究
Jacob E Kurlander1,2,3, Loren Laine4,5, Hyungjin Myra Kim6
1VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA jkurland@umich.edu.
一个以药房为基础的干预成功地减少了在一个大型医疗保健系统中过度使用质子抑制剂 (PPI). 虽然PPI的处方减少了,但观察到的显著临床益处或危害的证据很少.
科学领域:
- 药理学 药理学是指药理学的学科.
- 医疗保健服务研究 医疗服务研究
- 胃肠病学 胃肠病学
背景情况:
- 质子抑制剂 (PPI) 被广泛使用,导致人们担心过度使用.
- 确定优化PPI处方的有效策略对于患者安全和医疗保健效率至关重要.
研究的目的:
- 评估大规模的,多组件的,基于药房的干预对过度使用质子抑制剂 (PPI) 的影响.
- 评估干预对处方模式,医疗保健利用和临床结果的影响.
主要方法:
- 在美国退伍军人事务医疗保健系统中进行了一项差异差异研究.
- 一个区域网络实施了干预,而其他17个网络则作为控制,分析了2009-2019年的数据.
- 干预措施包括补充限制,处方失效,促进H2受体抗剂的处方,以及患者/临床医生的教育.
主要成果:
- 这项干预措施导致PPI处方的显著减少,总体绝对下降7.3%.
- 在适合胃保护的患者中,PPI的使用减少了11.3%.
- 没有观察到上部胃肠道诊断,内镜或相关住院病人的显著增加.
结论:
- 一种多组件的,基于药房的干预措施有效地减少了PPI的使用,包括在适当的患者群体中.
- 该干预表明,相关的临床益处或危害的证据很少,这表明需要进一步调查临床影响.
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