Study of the use of a spironolactone and angiotensin-converting enzyme inhibitor combination: a population-based analysis.
OBJECTIVE
To analyse the conditions of use of the drug combination in outpatients.


METHODS
The first section consisted of a population-based analysis using computerized records from the French national health insurance system. The study population consisted of adult patients, receiving long-term treatment with spironolactone (SPIR) and angiotensin-converting enzyme inhibitor (ACEI). For each patient, the reimbursement of serum potassium and creatinine determinations was searched for in the database during the 6-month period preceding the date of the last dispensation. The second section comprised a written questionnaire on use practises, sent to practitioners who prescribed the drug combination to randomly selected patients. Analysis of the answers to the questionnaire made it necessary to develop a reference system. In the third section, procedure one was repeated at a later stage, following an information campaign, in order to measure its impact.


RESULTS
The exhaustive population under procedure 1 consisted of 3620 patients (71 +/- 11 years). During the 6 months prior to the index date, 51% of patients underwent at least one determination of both serum potassium and serum creatinine. The randomised population under procedure two consisted of 441 patients (70 +/- 13 years) and their 375 practitioners. When compared with the reference system, SPIR-ACEI was used for the recommended indications, at the appropriate SPIR-ACEI dosages, and under minimal monitoring of biological parameters in only 65 patients (15%). After the information campaign, results were disappointing because only 55% of patients underwent the minimal laboratory monitoring.


CONCLUSIONS
The use of the drug combination in general practice was mainly inappropriate.
Besançon
Jean-François
JF
Service médical des Pays de Loire, 11 rue de Rame F49000 ANGERS, France.
Lagarce
Laurence
L
Diquet
Bertrand
B
Lainé-Cessac
Pascale
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D016208:Databases, Factual; D004232:Diuretics / Q000008:administration & dosage / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D004502:Education, Medical, Continuing / Q000379:methods; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000193:education; D011188:Potassium / Q000097:blood; D010818:Practice Patterns, Physicians' / Q000592:standards*; D012189:Retrospective Studies; D013148:Spironolactone / Q000008:administration & dosage / Q000627:therapeutic use*; D011795:Surveys and Questionnaires
D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D013148:Spironolactone; D003404:Creatinine; D011188:Potassium