Antipsychotics in dementia: prevalence and quality of antipsychotic drug prescribing in UK mental health services
Antipsychotics in dementia: prevalence and quality of antipsychotic drug prescribing in UK mental health services
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DOI：
10.1192/bjp.bp.111.107631
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发表时间：
2012-09-01
影响因子：
10.5
通讯作者：
Paton, Carol
中科院分区：
文献类型：
--
作者：
Barnes, Thomas R. E.;Banerjee, Sube;Paton, Carol
背景：在英国，每年有多达四分之一被诊断为痴呆症的人服用抗精神病药物。这种治疗的潜在风险正变得越来越清晰，但其益处仍不确定。2009年英国国家痴呆症战略表达了对此类处方的频率和质量的关注。目的评估英国二级精神卫生服务中抗精神病药物治疗痴呆的流行程度，并收集与此类处方实践的质量改进举措相关的数据。方法在英国质量改进计划的背景下，收集专业老年人心理健康服务护理下的痴呆患者的相关临床审计数据。结果54家国民健康服务（NHS）信托机构提交了10199例患者的心理健康数据。在那些没有共病精神病的患者中，1620人（16%）服用了抗精神病药物；这种药物的常见临床适应症是躁动、精神病症状、攻击和痛苦。多变量回归发现，年龄更小、养老院或住院环境、血管性或帕金森性痴呆以及更严重的痴呆都与处方抗精神病药物显著相关。在1001名（62%）接受治疗超过6个月的患者中，只有四分之三的患者在过去6个月有治疗反应的文献回顾。结论：这些数据揭示了目前相对较好的实践领域，包括考虑抗精神病药物的替代方案和明确的目标症状记录。他们还提出了一些需要改进的地方，比如长期用药的检查频率和质量。减少抗精神病药物使用的策略应考虑到预测抗精神病药物处方增加可能性的人口统计学和临床变量。
BackgroundUp to a quarter of people in the UK with a diagnosis of dementia are prescribed an antipsychotic in any year. The potential risks of such treatment are becoming clearer, but the benefits remain uncertain. Concern about the frequency and quality of such prescribing was expressed in the National Dementia Strategy for England in 2009.AimsTo provide an estimate of the prevalence of antipsychotic use for dementia in secondary mental health services in the UK and to collect data relevant to quality improvement initiatives for such prescribing practice.MethodIn the context of a UK quality improvement programme, relevant clinical audit data were collected for patients with dementia under the care of specialist older people's mental health services.ResultsFifty-four mental health National Health Service (NHS) trusts submitted data on 10 199 patients. Of those patients without comorbid psychotic illness, 1620 (16%) were prescribed an antipsychotic; the common clinical indications for such medication were agitation, psychotic symptoms, aggression and distress. Multivariable regression found younger age, care home or in-patient setting, vascular or Parkinson's disease dementia and greater severity of dementia to be all significantly associated with being prescribed antipsychotic medication. Of the 1001(62%) patients prescribed treatment for more than 6 months, only three-quarters had a documented review of therapeutic response in the previous 6 months.ConclusionsThe data reveal areas of relatively good current practice, including consideration of alternatives to antipsychotic medication and clear documentation of target symptoms. They also suggest areas for improvement, such as the frequency and quality of review of long-term medication. Strategies to reduce antipsychotic use should take account of the demographic and clinical variables predicting increased likelihood of antipsychotic prescription.