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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 蒙恩 | 法國良性前列腺肥造成的下尿路症狀的實際醫療狀況：全面性的總體人口研究 | 2013/11/21 下午 04:40:26 | 0 |
| 原 文 | 題 目 | Management of Lower Urinary Tract Symptoms Related to Benign Prostatic Hyperplasia in Real-life Practice in France: A Comprehensive Population Study |
| 作 者 | Bertrand Lukacs, Jean-Nicolas Cornu, Mounir Aout, Natacha Tessier, Christophe Hodee, Francois Haab, Olivier Cussenot, Yvon Merliere, Veronique Moysan and Eric Vicaut | |
| 出 處 | European Urology, Volume 64 (3),2013, 493-501 | |
| 出版日期 | Sep, 2013 | |
| 評 論 |
男性下尿路症狀（LUTS ）是最常被治療的疾病之一，但很少有人知道目前有關病人臨床治療的軌跡到底是什麼。此篇主要描述因良性前列腺阻塞（ BPO ）造成的下尿路症狀可能的動態治療模式。作者由2004至2008年隸屬於法國國民健康保險系統且覆蓋整個人口的兩個不同行政索賠數據庫，取得所有有關BPO的所有處方，包括α1 -腎上腺素受體阻斷劑（ α1 -blocker） ， 5α-還原酶抑制劑（5 - ARIs） ，植物療法(phytotherapy)及手術治療的數據。連接兩個資料庫後，分析每一個病人的連續治療事件。此研究針對每一年，每一地區所開出的藥物處方及開處方的醫師進行了分析評估。也對藥物治療的開始，中斷，演變，及手術治療後的事件（住院天數，再手術，併發症的發生率，及後續的藥物處方）進行分析。 總體來看，2,620,269例收治患者在5年之內，具有重要的治療軌跡變化。約16％的患者中斷藥物治療。α1-受體阻斷劑的處方最頻繁，而令人驚訝的是植物療法佔所有單一療法的27％和所有組合療法 (combination therapies) 的54％。家庭醫生和泌尿科醫生（整體開出處方，分別為92 ％和3.7％ ）表現出類似的處方模式。 95.4％的起始治療是藥物治療，主要使用單一藥物治療病患：α1-受體阻滯劑佔60.3％，植物療法佔31.8％，或5α-還原酶抑制劑佔7.9％。另外在起始治療開始12個月內很多醫師會更改原來的治療方法（分別為8.7 ％，14.6 ％，和12.9％ ）。手術後的平均住院時間則是遠遠高於之前在臨床試驗中所報告的。接受開放性前列腺切除術(open prostatectomy)的病人較不需接受再次手術，且其後續產生的手術併發症比率較經尿道內視鏡手術為低。手術後12個月內的要再用藥物治療比率高達13.8％。 這種獨特的對於臨床實際醫療行為動態評估發現了意想不到的結果，與先前公佈的臨床試驗證據不同。這種動態評估法可能值得用來監測和控管特定疾病的醫療政策，提供專業科研人員和政府健康主管機關一些思考方向，以提高醫療水平。 |
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| abstract |
Background Male lower urinary tract symptoms (LUTS) are one of the most treated diseases, but little is known about patient trajectories in current clinical practice. Objective To describe the dynamic treatment patterns of LUTS presumably due to benign prostatic obstruction (BPO). Design, settings, and participants All prescriptions of α1-adrenergic receptor blocking agents (α1-blockers), 5α-reductase inhibitors (5-ARIs), and phytotherapy, and all surgeries related to BPO performed in France from 2004 to 2008 were identified using two distinct administrative claim databases maintained by the National Health Insurance system that covers the entire population. After linking the two data sets, all consecutive treatment events were analyzed for each patient. Outcome measurements and statistical analysis Drug prescription details were assessed for each year, region, and prescriber qualification. Medical treatment initiation, interruption, evolution, and events after surgical management (hospital stay, reoperation, complication rates, and subsequent medical prescriptions) were also investigated. Results and limitations Overall, 2 620 269 patients were treated within 5 yr, with important geographic variations. Medical treatment was interrupted for approximately 16% of patients. The α1-blockers were prescribed most frequently, but phytotherapy surprisingly accounted for 27% of all monotherapies and 54% of all combination therapies. General practitioners and urologists (92% and 3.7% of overall prescribers, respectively) exhibited a similar prescription profile. Treatment initiation was medical in 95.4% of cases, consisting primarily of monotherapy using α1-blockers (60.3%), phytotherapy (31.8%), or 5-ARIs (7.9%). Treatment was modified at extremely high rates within 12 mo of initiation (8.7%, 14.6%, and 12.9%, respectively). The median hospital stay for surgical management was far higher than in clinical trials. Long-term surgical complications and reoperation rates favored open prostatectomy. Incidence of pharmacologic treatment after surgery was as high as 13.8% at 12 mo. Conclusions This unique dynamic evaluation of clinical practice revealed unexpected results that contrast with previously published evidence from clinical trials. This approach may merit monitored and targeted measures to improve the level of care in the field. |
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