Prevalence, trends, and factors associated with antipsychotic polypharmacy among medicaid-eligible schizophrenia patients, 1998-2000
Prevalence, trends, and factors associated with antipsychotic polypharmacy among medicaid-eligible schizophrenia patients, 1998-2000
复制标题
DOI：
10.4088/jcp.v65n1013
复制
发表时间：
2004-10-01
影响因子：
5.3
通讯作者：
Martin, BC
中科院分区：
文献类型：
--
作者：
Ganguly, R;Kotzan, JA;Martin, BC
目的：根据抗精神病药物的使用类型和持续时间，确定抗精神病药物综合用药的流行率、趋势和相关因素，并将使用模式与已发表的治疗指南进行比较。方法：设计一项回顾性队列研究，从加利福尼亚州(20%随机抽样)和佐治亚州医疗补助索赔数据库中确定1998年至2000年期间被诊断为精神分裂症(ICD-9-CM=295.xx)的16岁医疗补助受助者。抗精神病药物复合用药的使用根据持续时间进行分类(长期复合用药定义为持续2个月)，长期使用根据抗精神病药物组合的类型进一步分类(氯氮平、常规和非典型)。对抗精神病药物复合用药的流行率、平均持续时间、频率和年度趋势进行了估计。结果：在31,435例精神分裂症患者中，1998-2000年抗精神病药物多药治疗的患病率为40%(N=12,549；平均年龄=43岁；白人，47%；女性，48%；平均用药时间=149天)，长期抗精神病药物多药治疗的患病率为23%(N=7222，平均用药时间=236天)。1998年至2000年间，非典型抗精神病药物复合药房的流行率有所上升(p<；.0001)。使用较新的非典型药物如奎硫平(OR=18.32)和较老的常规药物如氯丙嗪(OR=28.87)与长期使用抗精神病药物多药密切相关。结论：抗精神病药物多药治疗广泛流行，用药时间长，并且在符合医疗补助条件的精神分裂症患者中日益增多，这表明与治疗指南有显著差异(该指南不提倡使用任何多药药物，除非患者过渡到新的抗精神病药物的短期)。进一步的研究评估抗精神病药在精神分裂症患者中的效果可能有助于确定这种使用的范围和潜力。
Objective: To determine the prevalence, trends, and factors associated with antipsychotic polypharmacy categorized according to type of antipsychotic and duration of use and to contrast usage patterns with published treatment guidelines.Method: A retrospective cohort study was designed, and Medicaid recipients ! 16 years of age with a schizophrenia diagnosis (ICD-9-CM = 295 .xx) between 1998 and 2000 were identified from the California (20% random sample) and Georgia Medicaid claims databases. Use of antipsychotic polypharmacy was categorized based on duration (long-term polypharmacy was defined as lasting > 2 months), and long-term use was further categorized based on type of antipsychotic combinations (clozapine, conventional, and atypical). The prevalence, mean duration, and frequency of and yearwise trends in antipsychotic polypharmacy were estimated. A stepwise logistic variable selection procedure was used to identify factors associated with long-term antipsychotic polypharmacy.Results: Of a total of 31,435 persons with schizophrenia, the 1998-2000 prevalence of antipsychotic polypharmacy was 40% (N = 12,549; mean age = 43 years; white, 47%; female, 48%; mean duration of polypharmacy = 149 days), and long-term antipsychotic polypharmacy prevalence was 23% (N = 7222, mean duration = 236 days). The prevalence of atypical antipsychotic polypharmacy increased between 1998 and 2000 (p < .0001). Use of newer atypicals such as quetiapine (OR = 18.32) and older conventionals such as chlorpromazine (OR = 28.87) was strongly associated with long-term antipsychotic polypharmacy.Conclusion: Antipsychotic polypharmacy is widely prevalent, is prescribed for long durations, and is an increasing phenomenon among Medicaid-eligible schizophrenia patients, indicating a significant discrepancy with treatment guidelines (which do not advocate the use of any polypharmacy except for short-term periods when transitioning patients to new antipsychotics). Further research evaluating the effects of antipsychotic polypharmacy in schizophrenia patients may assist in defining the scope and potential of such use.