| アブストラクト | PURPOSE: To examine variation in oral, injectable, and inhaled corticosteroid (CS) prescribing in primary care, exploring treatment persistence and coverage. METHODS: We examined patient-level electronic health records from English general practices in the Clinical Practice Research Datalink Aurum database. We delineated a cohort of new users of oral, injectable, or inhaled CS with prescriptions issued between January 1, 2000, and June 30, 2021. Lorenz curves assessed potential prescribing skewness, and Kaplan-Meier (KM) plots estimated treatment persistence. The Proportion of Patients Covered (PPC) method estimated the proportion of patients still covered by treatment 1 year after initiation. RESULTS: We observed 1 942 571 CS users across 1471 general practices, with 20% of oral and inhaled CS users accounting for almost 80% of total CS use. Older patients with comorbidities including respiratory diseases (13.5%), skin conditions (5.8%), or inflammatory bowel diseases (1.6%) were more likely to be prescribed higher doses. The KM plots showed that 20% of oral and 50% of inhaled CS users were persistent after one and 2 months, respectively. The PPC method indicated that 30% of oral and 60% of inhaled CS users were covered by treatment 6 months post-initiation. Some variation was observed when different grace periods were applied. Combined use of oral and inhaled CS was observed for 6.9% of patients. CONCLUSION: A fifth of patients receiving CS accounted for over 80% of oral and inhaled CS prescribing in primary care. Identifying these patients is crucial for targeting future interventions to promote patient safety and cost-effective CS use. |
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| 投稿者 | Domzaridou, Eleni; Carr, Matthew J; Williams, David M; Avery, Anthony J; van Staa, Tjeerd; Rees, D Aled; Ashcroft, Darren M |
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| 組織名 | Nuffield Department of Population Health, University of Oxford, Oxford, UK.;National Institute for Health and Care Research (NIHR) Greater Manchester Patient;Safety Research Collaboration (GM PSRC), School of Health Sciences, Faculty of;Biology, Medicine and Health, University of Manchester, Manchester, UK.;Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy &;Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health,;University of Manchester, Manchester, UK.;Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff,;UK.;Centre for Primary Care, School of Medicine, University of Nottingham,;Nottingham, UK.;Centre for Health Informatics, Imaging and Data Science, Faculty of Biology,;Medicine and Health, University of Manchester, Manchester Academic Health Science;Centre, Manchester, UK. |
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