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The effect of screening for cardio‐renal risk factors on drug use in the general population
Author(s) -
Atthobari Jarir,
Gansevoort Ron T.,
Visser Sipke T.,
De Jong Paul E.,
De Jongvan den Berg Lolkje T. W.
Publication year - 2007
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2007.02988.x
Subject(s) - medicine , population , drug , medical prescription , cohort , incidence (geometry) , albuminuria , kidney disease , pharmacology , environmental health , physics , optics
What is already know about this subject • Screening of the population may result in medicalization. • There is no report about the effect of a health screening programme on drug prescribing. What this study adds • Screening of the general population for cardiovascular risk factors does not lead to more drug prescribing, for either screening‐related or screening‐unrelated drugs. • The incidence of drug use increases in screened subjects with high risk, but only for drugs related to the purpose of screening. • For screening to be successful, i.e. increased drug use in the detected diseased subjects, it has to be performed in a population expected to be at increased risk. Aim To evaluate the effect of a cardio‐renal screening programme on desired and undue drug use. Methods Data from the PREVEND cohort (Prevention of REnal and Vascular ENd‐stage Disease) were used. The drug use of screened (randomly) selected subjects ( n = 2650) was compared with unscreened subjects, matched for age and sex ( n = 10 434). Drug use in the overall PREVEND cohort, enriched for albuminuria ( n = 6751), was also studied. Screening‐related drugs (antihypertensive, antilipidaemic, antidiabetic and antithrombotic) were selected, as well as screening‐unrelated drugs (benzodiazepines, drugs for acid‐related disorders and painkillers). Time to first prescription after screening is presented as Kaplan–Meier curves. Results After 6.5 years of follow‐up, the incidence of drug use was not significantly different between the screened, randomly selected and unscreened cohorts. Antihypertensives were used by 21.5 and 20.8%, respectively; antilipidaemic 12.8 and 10.2%, antidiabetics 4.0 and 3.9%, and antithrombotic 11.4 and 12.0%. Screening‐unrelated drugs were used at comparable frequencies. Compared with the unscreened cohort, screening‐related drugs were prescribed more frequently for subjects in the enriched cohort (25.8, 15.5, 5.5 and 13.5% for antihypertensive, antilipidaemic, antidiabetic and antithrombotic, respectively), whereas screening‐unrelated drugs were used at comparable frequencies. Conclusions The incidence of drug use did not differ between the screened, randomly selected and unscreened cohorts. Screening does not lead to more drug prescription, thus arguing against the fear of undue medicalization after screening. The data also show that, for screening to be successful, it should be performed in a targeted population, such as one enriched for albuminuria.