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首页> 外文期刊>Allergy, Asthma & Clinical Immunology >Electronic health record-based assessment of oral corticosteroid use in a population of primary care patients with asthma: an observational study
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Electronic health record-based assessment of oral corticosteroid use in a population of primary care patients with asthma: an observational study

机译：基于电子健康记录的哮喘初级保健患者中口服糖皮质激素的使用评估：一项观察性研究

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Background Oral corticosteroid prescriptions are often used in clinical studies as an indicator of asthma exacerbations. However, there is rarely the ability to link a prescription to its associated diagnosis. The objective of this study was to characterize patterns of oral corticosteroid prescription orders for asthma patients using an electronic health record database, which links each prescription order to the diagnosis assigned at the time the order was placed. Methods This was a retrospective cohort study of the electronic health records of asthma patients enrolled in the Geisinger Health System from January 1, 2001 to August 23, 2010. Eligible patients were 12–85?years old, had a primary care physician in the Geisinger Health System, and had asthma. Each oral corticosteroid order was classified as being prescribed for an asthma-related or non-asthma-related condition based on the associated diagnosis. Asthma-related oral corticosteroid use was classified as either chronic or acute. In patient-level analyses, we determined the number of asthma patients with asthma-related and non-asthma-related prescription orders and the number of patients with acute versus chronic use. Prescription-level analyses ascertained the percentages of oral corticosteroid prescription orders that were for asthma-related and non-asthma-related conditions. Results Among the 21,199 asthma patients identified in the electronic health record database, 15,017 (70.8%) had an oral corticosteroid prescription order. Many patients (N?=?6,827; 45.5%) had prescription orders for both asthma-related and non-asthma-related conditions, but some had prescription orders exclusively for asthma-related (N?=?3,450; 23.0%) or non-asthma-related conditions (N?=?4,740; 31.6%). Among the patients receiving a prescription order, most (87.5%) could be classified as acute users. A total of 60,355 oral corticosteroid prescription orders were placed for the asthma patients in this study—31,397 (52.0%) for non-asthma-related conditions, 24,487 (40.6%) for asthma-related conditions, and 4,471 (7.4%) for both asthma-related and non-asthma-related conditions. Conclusions Oral corticosteroid prescriptions for asthma patients are frequently ordered for conditions unrelated to asthma. A prescription for oral corticosteroids may be an unreliable marker of asthma exacerbations in retrospective studies utilizing administrative claims data. Investigators should consider co-morbid conditions for which oral corticosteroid use may also be indicated and/or different criteria for assessing oral corticosteroid use for asthma.
机译：背景技术口服皮质类固醇处方通常在临床研究中用作哮喘恶化的指标。但是，很少有将处方与其相关的诊断联系起来的能力。这项研究的目的是使用电子健康记录数据库来表征哮喘患者口服皮质类固醇处方药的模式，该数据库将每个处方药与下单时分配的诊断联系起来。方法这是一项回顾性队列研究，研究对象是2001年1月1日至2010年8月23日加入Geisinger卫生系统的哮喘患者的电子健康记录。符合条件的患者年龄为12-85岁，在Geisinger有初级保健医生卫生系统，并患有哮喘。根据相关的诊断，每项口服皮质类固醇激素订单均被分类为针对哮喘相关或非哮喘相关疾病的处方药。哮喘相关的口服糖皮质激素的使用被分类为慢性或急性。在患者水平分析中，我们确定了患有哮喘相关和非哮喘相关处方药的哮喘患者的数量以及急性和慢性使用哮喘患者的数量。处方水平分析确定了与哮喘有关和与哮喘无关的状况的口服糖皮质激素处方的百分比。结果在电子健康记录数据库中识别出的21199例哮喘患者中，有15017例（70.8％）有口服糖皮质激素处方令。许多患者（N？=？6,827; 45.5％）对哮喘相关和非哮喘相关病症都有处方药订单，但有些患者仅针对哮喘相关（N？=？3,450; 23.0％）或非哮喘相关处方药-与哮喘有关的疾病（N≥4,740; 31.6％）。在接受处方药的患者中，大多数（87.5％）可以归为急性使用者。在这项研究中，总共为哮喘患者下了60355份口服皮质类固醇处方药订单-非哮喘相关疾病为31,397（52.0％），哮喘相关疾病为24,487（40.6％），两者均为4,471（7.4％）哮喘相关和非哮喘相关疾病。结论对于哮喘患者，经常订购与哮喘无关的口服皮质类固醇处方。在使用行政要求数据的回顾性研究中，口服皮质类固醇的处方可能是哮喘加重的不可靠指标。研究者应考虑可能同时提示口服皮质类固醇使用的合并症和/或评估哮喘患者口服皮质类固醇使用的不同标准。

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