行政药房的协议与美国退伍军人与类风湿性关节炎的口服普雷德尼松的自我报告使用进行分发
Beth I Wallace1, Bryant R England2, Joshua F Baker3
1VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan.
Arthritis care & research
|June 2, 2025
概括
行政主张准确地评估了风湿性关节炎 (RA) 患者口服葡萄糖皮质体 (普雷尼松) 的使用情况. 索赔数据显示高有效性,但由于库存或非VA处方,可能会错过一些使用.
科学领域:
- 类风湿病学 类风湿病学
- 药理流行病学 药理流行病学
- 医疗信息学 医疗信息学
背景情况:
- 行政声明经常用于评估口服葡萄糖皮质体在类风湿性关节炎 (RA) 中的使用情况.
- 然而,这些基于索赔的算法的准确性尚未得到充分证实.
- 这项研究解决了需要验证索赔数据与患者在RA中使用葡萄糖皮质类药物的自我报告对抗的需求.
研究的目的:
- 评估使用行政索赔算法的性能,以确定RA患者口服葡萄糖皮质类药物 (普雷尼松) 的使用情况.
- 为了比较基于索赔的葡萄糖皮质激素使用检测与患者自我报告的准确性.
主要方法:
- 利用了退伍军人事务风湿关节炎 (VARA) 注册表中的284名RA患者的数据.
- 开发了使用VA处方索赔的算法来定义目前使用,剂量和90天使用的普得尼松.
- 评估算法性能 (灵敏度,特异性,PPV,NPV) 和一致性 (科恩的 κ) 与患者的自我报告.
主要成果:
- 与自我报告相比,基于索赔的算法在检测当前 (PPV 0.84) 和90天的普得尼松使用 (PPV 0.72) 中具有很高的有效性.
- 对于每天≤5毫克的普得尼松剂量 (加权 κ 0.67) 观察到高一致性.
- 很大一部分患者报告说他们储存了前尼松 (25%) 或非VA处方 (25%),这可能会影响算法灵敏度.
结论:
- 使用VA处方声明的算法是评估RA患者使用普得尼松的有效方法.
- 这些算法的中度灵敏度凸显了储存和非VA处方对索赔数据的影响.
- 结果支持使用声明数据进行现实世界RA研究,同时为超越声明的葡萄糖皮质体使用的临床估计提供信息.
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