2015-2021 年加拿大初级保健人群中噻嗪类利尿剂的处方趋势

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS CJC Open Pub Date : 2024-06-01 DOI:10.1016/j.cjco.2024.03.001
Catherine Ji MD, MSc , Jemisha Apajee MPhil , Ellen Stephenson PhD , Karen Tu MD, Msc
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引用次数: 0

摘要

背景加拿大2017年高血压指南倾向于使用噻嗪类(TZ)利尿剂,如CLTD(氯沙利酮)和吲哒帕胺(IND),而不是氢氯噻嗪(HCTZ)。加拿大卫生部在2019年警告说,HCTZ可能与皮肤癌风险增加有关。我们的研究调查了加拿大安大略省从2015年到2021年TZ处方的变化情况。研究方法利用多伦多大学基于实践的研究网络数据库(主要覆盖大多伦多地区)中的电子病历数据,对成人高血压患者进行了一项回顾性队列研究。研究结果包括每月获得 HCTZ、CLTD 或 IND 处方的患者比例。采用间断时间序列分析来评估 2017 年指南和 2019 年安全警告发布后的结果变化。根据处方医生的性别和医学院毕业年份对处方趋势进行了分层。结果共有 100,428 名高血压患者被纳入队列,其中 31,700 名患者从 343 名家庭医生处获得了至少一张 TZ 处方。我们发现,随着时间的推移,HCTZ处方量呈下降趋势,同时IND和CLTD处方量有所增加,在2017年指南发布和2019年所有3种药物的安全警告发布后,处方率发生了统计学意义上的显著变化,但这种变化是短暂的。在加拿大卫生部安全警告发布后,女性医生和早期职业医生的处方率变化比她们的同行更快。结论近年来,TZ 利尿剂处方模式发生了变化,但加拿大高血压协会 2017 年指南和 2019 年加拿大卫生部安全警告并未对 HCTZ、IND 和 CLTD 处方率的变化产生持续的重大影响。
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Prescription Trends of Thiazide Diuretics in a Canadian Primary Care Population From 2015 to 2021

Background

Hypertension Canada 2017 guidelines favoured the use of thiazide (TZ)-like diuretics, such as CLTD (chlorthalidone) and indapamide (IND) over hydrochlorothiazide (HCTZ). Health Canada warned in 2019 that HCTZ may be associated with increased risk of skin cancer. Our study looked at the changes in TZ prescriptions from 2015 to 2021 in Ontario, Canada.

Methods

A retrospective cohort study was conducted of adults with hypertension, using electronic medical record data from the University of Toronto Practice-Based Research Network database covering mostly the Greater Toronto area. Outcomes included the proportion of patients who received a prescription of HCTZ, CLTD, or IND each month. Interrupted time-series analysis was used to evaluate the change in outcomes after publication of the 2017 guidelines and 2019 safety warning. Prescription trends were stratified by prescribing physicians’ sex and year of medical school graduation.

Results

A total of 100,428 patients with hypertension were included in the cohort, with 31,700 patients who received at least one TZ prescription from 343 family physicians. We found a declining trend in HCTZ prescriptions over time, accompanied by an increase in IND and CLTD prescriptions, with statistically significant but transient changes in prescription rates after publication of the 2017 guidelines and the 2019 safety warning for all 3 medications. Female physician and early-career physician prescription rates changed faster than that of their counterparts immediately after the Health Canada safety warning was issued.

Conclusions

TZ diuretic prescription patterns have changed in recent years, but Hypertension Canada’s 2017 guidelines and the 2019 Health Canada safety warning did not have a sustained significant impact on the change in prescription rates of HCTZ, IND, and CLTD.

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来源期刊
CJC Open
CJC Open Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
143
审稿时长
60 days
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