| Summary: | 碩士 === 國立成功大學 === 臨床藥學研究所 === 84 === Background ?Due to an increase in the elderly population and
change of dietary habit, the incidence of coronary heart
disease has increased in the past decade. Cholesterol reduction
is generally accepted as an effective way to prevent coronary
heart disease. The treatment for hyperlipidemia should undergo
in a specific procedure, medical management and patients''
compliance both affect the therapeutic outcome. We conducted a
prospective drug utilization evaluation program focusing on four
antihyperlipidemic agents (Gemfibrozil, Lovastatin, Pravastatin
and Acipimox) to compare prescribing patterns between two groups
before and after intervention. We also explore the patients''
behavior through telephone interviewing.Method ?We developed
the Antihyperlipidemic Agent Usage Guideline and announced the
guideline to physician in National Cheng-Kung University
Hospital by the Pharmacy Forum. We selected the new users who
never took antihyperlipidemic agents and were prescribed
antihyperlipidemic agents during 1994/10/1 to 1994/12/31 as pre-
intervention subjects. After the intervention phase, patients
who were new users during 1995/10/1 to 1995/12/31 become the
post-intervention subjects. Two groups of patients were followed
up for six and four months, respectively. Patients'' data
obtained from medical charts and telephone interview. Results ?
After medical chart review and telephone interview, there were
128 and 192 subjects in each groups (age range from 11 to 82
years). No significant response to the intervention was noted
between two groups in ll aspects. There were 10.2% versus 14.1%
complied with the indications of the Guideline, p=0.30.
Although, the patient number without baseline lipid profile
significantly decreased (p=0.031), most of the cases had only
one lipid profile before prescribing. Only 2 cases (1.6%) and 4
cases (2.1%) pre- and post- intervention were completely met
with the Guideline requirement for baseline measurement.
Significant deterioration in checking LDL-D and HDL-C was also
noted. The dosage of gemfibrozil and acipimox were found to be
lower than general recommendation. Sixty-three and ninety-two
patients discontinued the drug less than three months, and they
spent NT 67,640 dollars and NT 134,436 dollars for the
medication., about 20.5% and 25.1% of total costs. Only 40-50%
of patients took medicine as ordered, and 59.4% and 66.1% kept
with the nonpharmacologic therapy after taking medicine.
Discontinuation rates in four months were 43.8% and 39.1% in
each group. There were respectively 57.1% and 65.3% withdrew by
patients; most of them discontinued due to stopping visiting,
18.8% and 18.4% because of adverse effects. Overall, there are 6
patients (4.7%) and 13 patients (6.8%) who suffered adverse drug
reactions in each group.Conclusion ?An announcement of the
Guideline by medium may not be effective on changing physicians''
prescribing behavior. To promote the appropriate use of
antihyperlipidemic agents clinically and save medical cost, a
more compulsory program may be necessary. rease in the elderly
population and change of dietary
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