Prescribing Trends in Veterans With Posttraumatic Stress Disorder
Prescribing Trends in Veterans With Posttraumatic Stress Disorder
复制标题
DOI：
10.4088/jcp.11m07311
复制
发表时间：
2012-03-01
影响因子：
5.3
通讯作者：
Friedman, Matthew J.
中科院分区：
文献类型：
--
作者：
Bernardy, Nancy C.;Lund, Brian C.;Friedman, Matthew J.
目的：修订后的退伍军人事务部（VA）和国防部创伤后应激管理临床实践指南建议不长期使用苯二氮卓类药物来治疗创伤后应激障碍（PTSD）。一项对在退伍军人管理局接受PTSD治疗的退伍军人最近趋势的分析指出，服用苯二氮卓类药物的比例正在下降。作者检查了其他药物的处方模式，以便更好地了解VA苯二氮卓类药物处方变化的总体背景。方法：使用1999 - 2009财政年度的VA管理数据，使用从住院出院和门诊就诊中提取的CD-9代码来识别患有PTSD的退伍军人。使用处方药物档案确定每个财政年度的抗抑郁药、抗精神病药和催眠药的处方。结果：接受临床实践指南推荐的两种PTSD一线药物治疗（选择性5 -羟色胺再摄取抑制剂和5 -羟色胺-去甲肾上腺素再摄取抑制剂）的退伍军人比例从1999年的49.7%上升到2009年的58.9%。除了苯二氮卓类药物的处方减少外，抗精神病药物的总体使用频率也下降了6.1%，从1999年的20.0%降至2009年的13.9%。2008年唑吡坦加入退伍军人管理局国家处方后，非苯二氮卓类催眠药物的处方量增加了两倍。丁螺环酮的处方稳步减少，而哌唑嗪的处方增加了近7倍。结论：这项工作强调了过去十年中PTSD退伍军人处方的几个临床重要趋势，这些趋势与修订后的VA/国防部临床实践指南建议基本一致。然而，研究结果说明了管理数据的局限性，并指出需要通过与提供者的访谈对PTSD处方进行定性检查来补充这项工作，以更好地了解用于制定药物管理决策的策略。临床精神病学杂志2012；(3)版权所有2012年医师研究生出版社股份有限公司。
Objective: The revised Department of Veterans Affairs (VA) and Department of Defense Clinical Practice Guideline for Management of Post-Traumatic Stress recommends against long-term use of benzodiazepines to manage posttraumatic stress disorder (PTSD). An analysis of recent trends among veterans receiving care for PTSD in the VA noted a decreasing proportion receiving benzodiazepines. The authors examined prescribing patterns for other medications to better understand the general context in which the changes in benzodiazepine prescribing have occurred in the VA.Method: Administrative VA data from fiscal years 1999 through 2009 were used to identify veterans with PTSD using /CD-9 codes extracted from inpatient discharges and outpatient encounters. Prescribing of antidepressants, antipsychotics, and hypnotics was determined for each fiscal year using prescription drug files.Results:The proportion of veterans receiving either of the 2 Clinical Practice Guideline-recommended first-line pharmacotherapy treatments for PTSD, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, increased from 49.7% in 1999 to 58,9% in 2009. In addition to reduced benzodiazepine prescriptions, the overall frequency of antipsychotic use declined 6.1%, from 20.0% in 1999 to 13.9% in 2009. Nonbenzodiazepine hypnotic prescribing tripled when zolpidem was added to the VA national formulary in 2008. Buspirone prescribing decreased steadily, while prazosin prescribing expanded nearly 7-fold.Conclusions: This work highlights several clinically important trends in prescribing over the past decade among veterans with PTSD that are generally consistent with the revised VA/Department of Defense Clinical Practice Guideline recommendations. However, the findings illustrate the limitations of administrative data and point to a need to supplement this work with a qualitative examination of PTSD prescribing from interviews with providers to better understand the strategies used to make medication management decisions. J Clin Psychiatry 2012;73(3):297-303 (C) Copyright 2012 Physicians Postgraduate Press, Inc.