在阿尔茨海默氏症患者的抗粉胺治疗中,患者的旅程和决策过程
Brant Mittler1, Xavier Cambi2,3, Morgan Biskach2,3
1UT Health San Antonio, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
Journal of neurology
|April 16, 2025
概括
由于患者偏好和临床医生的决定等因素,很少有患者接受抗粉样蛋白治疗 (AAT). 了解这些障碍是改善阿尔茨海默氏症患者获得AAT的关键.
科学领域:
- 神经学 神经学
- 老年病的医生 老年病的医生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 退伍军人事务医疗保健系统管理数据库被用来检查抗粉样蛋白治疗 (AAT) 的临床决策.
- 抗粉样蛋白疗法是阿尔茨海默病的关键治疗方法,需要对其可访问性和影响其处方的因素有充分的了解.
研究的目的:
- 在退伍军人事务医疗保健系统内调查临床决策过程和患者选择抗粉样蛋白疗法 (AAT).
- 确定影响患者资格和接受AAT的障碍和促进者.
主要方法:
- 对于2023年3月至2024年6月期间提到lecanemab的临床笔记的患者,进行了电子健康记录的回顾性审查.
- 使用手动审查和结构化数据库查询来分析患者数据,包括人口统计,并发病症以及AAT排除或包含原因.
主要成果:
- 在最初的2499名患者中,有1064人被审查,只有5.3%最终成为候选人,计划或接受AAT.
- 接受AAT治疗的患者的并发症比被排除在外的患者少,关键的排除原因包括缺乏患者兴趣,资源限制,抗凝剂使用和晚期阿尔茨海默病 (AD).
- 从AAT排除的具体记录原因包括患者兴趣/资源限制 (24.6%),抗凝剂使用 (23.1%),以及晚期AD (18.6%).
结论:
- 患者的偏好和临床医生的裁量权对患者接受AAT的旅程产生重大影响.
- 可修改的因素,如药物治疗方案和患者参与,在AAT可访问性方面发挥着至关重要的作用.
- 患者达到AAT的比例很低,这凸显了需要制定战略来克服已识别的障碍并改善治疗机会.
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