Treatment pathway and patterns of clozapine prescribing for schizophrenia in New Zealand
Treatment pathway and patterns of clozapine prescribing for schizophrenia in New Zealand
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DOI：
10.1345/aph.1k662
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发表时间：
2008-06-01
影响因子：
2.9
通讯作者：
Wheeler, Amanda J.
中科院分区：
文献类型：
--
作者：
Wheeler, Amanda J.
目的：描述氯氮平在精神分裂症患者中的治疗途径和使用模式，包括精神药物的共开处方，并比较新西兰奥克兰和北国地区社区精神卫生服务中氯氮平与非氯氮平精神分裂症治疗共开处方的程度。方法：对2004年10月31日接受社区精神卫生服务的成人门诊患者进行回顾性统计分析。收集到的所有服用抗精神病药物患者的数据包括人口统计数据（性别、年龄、种族）；主要诊断（精神疾病诊断与统计手册，第四版）；共病条件;精神疾病持续时间；精神招生;治疗信息（精神药物，剂量和给药途径）。如果氯氮平是在政府全额处方补贴（1999年2月）引入后开始使用的，则收集其他数据，包括开始使用的年份和既往抗精神病药物史。分析包括所有诊断为精神分裂症（包括分裂情感性障碍）的门诊患者。结果：2796例精神分裂症患者使用抗精神病药物；32.8%的患者服用氯氮平，平均剂量为372 mg/天，平均发病时间为9.7年。在政府资助氯氮平后开始治疗的患者（59.3%）在开始使用氯氮平之前接受过中位数为3种抗精神病药物；大多数治疗方案包括1个第二基因定量抗精神病药物（91.2%）。与非氯氮平患者相比，氯氮平患者不太可能同时服用其他抗精神病药物（11.7% vs 17.6%; p < 0.001）。氯氮平组和非氯氮平组的精神药物处方总数都较低（中位数为2）；对于氯氮平患者，第二种药物最有可能用于治疗唾液过多。结论：难治性精神分裂症门诊患者按预期比例服用氯氮平；然而，治疗延误的时间比建议的要长。有一些证据表明，难治性精神分裂症患者获得氯氮平的情况有所改善，这可能是由于政府补贴的引入、指南的传播或临床医生使用氯氮平经验的增加。在这个现实世界的环境中，精神分裂症门诊患者同时服用精神药物的数量很低；当与氯氮平同时使用时，它们最常用于控制不良反应。
OBJECTIVE: To describe the treatment pathway and patterns of clozapine use in patients with schizophrenia, including coprescribed psychotropic medications, and compare the extent of coprescribing of clozapine with that of non-clozapine schizophrenia treatment in community mental health services in the Auckland and Northland regions of New Zealand.METHODS: A retrospective chart review was conducted for adult outpatients receiving care from community mental health services on October 31, 2004. Data collected for all patients prescribed an antipsychotic included demographics (sex, age, ethnicity); principal diagnosis (Diagnostic and Statistical Manual of Mental Disorders, 4th edition); comorbid conditions; duration of mental illness; psychiatric admissions; and treatment information (psychotropic medications, with dose and route of administration). If clozapine had been started after the introduction of full government prescription subsidy (February 1999), additional data, including year of initiation and prior antipsychotic history, were collected. Analysis included all outpatients with a diagnosis of schizophrenia (including schizoaffective disorder).RESULTS: Antipsychotics were prescribed for 2796 schizophrenia patients; 32.8% were prescribed clozapine, with a mean dose of 372 mg/day and an average duration of illness of 9.7 years before starting clozapine. Patients who had started treatment after clozapine was funded by the government (59.3%) had received a median of 3 antipsychotic drugs prior to starting clozapine; most of the treatment regimens included 1 second-gene ration antipsychotic (91.2%). Clozapine patients were less likely to be coprescribed another antipsychotic compared with non-clozapine patients (11.7% vs 17.6%; p < 0.001). Both the clozapine and non-clozapine groups had a low total number of psychotropic medications prescribed (median 2); for clozapine patients, the second drug was most likely to be for treatment of hypersalivation.CONCLUSIONS: Outpatients with treatment-resistant schizophrenia were prescribed clozapine at expected rates; however, treatment was delayed longer than recommended. There is some evidence that access to clozapine for treatment-resistant schizophrenia has improved, possibly as the result of the introduction of government subsidy, guideline dissemination, or increasing experience of clinicians with use of clozapine. In this real-world environment, the number of concomitant psychotropic medications for outpatients with schizophrenia was found to be low; when used concomitantly with clozapine, they were most commonly used to manage adverse effects.