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法国医生收了礼,影响药物处方?
作者:小柯机器人 发布时间:2019/11/8 10:52:04

法国雷恩大学Pierre Frouard课题组宣布他们的最新研究,分析了2016年制药公司给法国全科医生的礼物和他们的药物处方模式之间的关系。相关论文11月6日在线发表在《英国医学杂志》上。

研究组对法国国家健康数据系统、国家健康保险系统和医疗透明数据库中的资料进行了一项回顾性研究。共分析了41257名全科医生,2016年他们在私营部门工作,且至少有5名注册患者。根据收到礼物的货币价值,将这些医生进行分组。

2013-2016年,未收礼的全科医生每次就诊的药物处方报销金额显著低于至少收礼一次的全科医生,而与收礼超过1000欧元的医生相比,每笔处方的药费平均减少5.33欧元;未收礼的全科医生使用非专利的抗生素、抗高血压药和他汀类药物的频率更高,比收礼超过1000欧元的医生分别高2.17%、4.24%和12.14%,差异均具有统计学意义。

2016年,与收礼超过240欧元的医生相比,未收礼的医生使用苯二氮卓类和血管舒张药的频率更低,其中苯二氮卓类比收礼240-999欧元的医生低0.68%,血管舒张药比收礼超过1000欧元的医生低0.15%。但血管紧张素转换酶(ACE)抑制剂使用频率更高,比收礼超过1000欧元的医生高1.67%。而关于阿司匹林、抗抑郁药和质子泵抑制剂的处方差异不显著。

研究组得出结论,未收取制药公司礼物的法国全科医生,比收取礼物的全科医生拥有更好的处方效率,且药费更低。

附:英文原文

Title: Association between gifts from pharmaceutical companies to French general practitioners and their drug prescribing patterns in 2016: retrospective study using the French Transparency in Healthcare and National Health Data System databases

Author: Bruno Goupil, Frédéric Balusson, Florian Naudet, Maxime Esvan, Benjamin Bastian, Anthony Chapron, Pierre Frouard

Issue&Volume: 2019/11/06

Abstract: 

Objective To evaluate the association between gifts from pharmaceutical companies to French general practitioners (GPs) and their drug prescribing patterns.

Design Retrospective study using data from two French databases (National Health Data System, managed by the French National Health Insurance system, and Transparency in Healthcare).

Setting Primary care, France.

Participants 41 257 GPs who in 2016 worked exclusively in the private sector and had at least five registered patients. The GPs were divided into six groups according to the monetary value of the received gifts reported by pharmaceutical, medical device, and other health related companies in the Transparency in Healthcare database.

Main outcome measures The main outcome measures were the amount reimbursed by the French National Health Insurance for drug prescriptions per visit (to the practice or at home) and 11 drug prescription efficiency indicators used by the National Health Insurance to calculate the performance related financial incentives of the doctors. Doctor and patient characteristics were used as adjustment variables. The significance threshold was 0.001 for statistical analyses.

Results The amount reimbursed by the National Health Insurance for drug prescriptions per visit was lower in the GP group with no gifts reported in the Transparency in Healthcare database in 2016 and since its launch in 2013 (no gift group) compared with the GP groups with at least one gift in 2016 (−€5.33 (99.9% confidence interval −€6.99 to −€3.66) compared with the GP group with gifts valued at €1000 or more reported in 2016) (P<0.001). The no gift group also more frequently prescribed generic antibiotics (2.17%, 1.47% to 2.88% compared with the ≥€1000 group), antihypertensives (4.24%, 3.72% to 4.77% compared with the ≥€1000 group), and statins (12.14%, 11.03% to 13.26% compared with the ≥€1000 group) than GPs with at least one gift between 2013 and 2016 (P<0.001). The no gift group also prescribed fewer benzodiazepines for more than 12 weeks (−0.68%, −1.13% to −0.23% compared with the €240-€999 group) and vasodilators (−0.15%, −0.28% to −0.03% compared with the ≥€1000 group) than GPs with gifts valued at €240 or more reported in 2016, and more angiotensin converting enzyme (ACE) inhibitors compared with all ACE and sartan prescriptions (1.67%, 0.62% to 2.71%) compared with GPs with gifts valued at €1000 or more reported in 2016 (P<0.001). Differences were not significant for the prescription of aspirin and generic antidepressants and generic proton pump inhibitors.

Conclusion The findings suggest that French GPs who do not receive gifts from pharmaceutical companies have better drug prescription efficiency indicators and less costly drug prescriptions than GPs who receive gifts. This observational study is susceptible to residual confounding and therefore no causal relation can be concluded.

DOI: 10.1136/bmj.l6015

Source: https://www.bmj.com/content/367/bmj.l6015

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj