Egberts A C, Veenstra M, de Jong-van den Berg L T
Utrecht Institute for Pharmaceutical Sciences Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht, The Netherlands.
Pharm World Sci. 1999 Jun;21(3):132-6. doi: 10.1023/a:1008675402004.
To map the prescribing habits of physicians in two different regions in the Netherlands with respect to antidepressant drug choice for first users.
Retrospective follow-up study.
All persons who received an antidepressant drug for the first time during October 1994 to September 1995 were identified from 29 community pharmacies situated in two regions in the Netherlands. Age, gender, type of prescriber, region and the concomitant use of certain groups of drugs as marker for certain diseases were evaluated as determinants for prescribing either a "classic" or a "second generation" antidepressant drug to first users using logistic regression analysis.
We identified 4,637 first users during the study period corresponding with an overall incidence density of 16 per 1,000 person-years. For the majority of first users of both regions, the same five antidepressants were prescribed. However, the two regions differed markedly with regard to the frequency of prescription of the individual antidepressants. Region of living was identified as the most important determinant of prescribing a certain category of antidepressant drugs to first users (OR 2.9 [95% CI 2.5-3.3]). Just a few patient characteristics were associated with antidepressant drug choice. The elderly were more likely to receive a classic antidepressant, as were patients concomitantly using anti-epileptics (OR 0.4 [95% CI 0.3-0.6]). Patients concomitantly using cardiac glycosides were more likely to receive a second generation antidepressant (OR 1.8 [95% CI 1.2-2.1]). With respect to age and the other patient characteristics studied, the same pattern was observed in both regions.
Regional differences contributed more to differences in prescribing habits than individual patient characteristics. In order to improve pharmacotherapy with antidepressant drugs relevant patient characteristics should more be taken into account.
绘制荷兰两个不同地区医生针对首次使用抗抑郁药物患者的用药习惯。
回顾性随访研究。
从荷兰两个地区的29家社区药房中确定所有在1994年10月至1995年9月期间首次接受抗抑郁药物治疗的患者。使用逻辑回归分析评估年龄、性别、开处方者类型、地区以及作为某些疾病标志物的特定药物组合的联合使用情况，作为向首次使用抗抑郁药物患者开具“经典”或“第二代”抗抑郁药物的决定因素。
在研究期间，我们确定了4637名首次使用抗抑郁药物的患者，总体发病率密度为每1000人年16例。两个地区的大多数首次使用抗抑郁药物的患者都被开具了相同的五种抗抑郁药物。然而，两个地区在个别抗抑郁药物的处方频率上存在显著差异。居住地区被确定为向首次使用抗抑郁药物患者开具某类抗抑郁药物的最重要决定因素（比值比2.9 [95%置信区间2.5 - 3.3]）。只有少数患者特征与抗抑郁药物的选择有关。老年人以及同时使用抗癫痫药物的患者更有可能接受经典抗抑郁药物（比值比0.4 [95%置信区间0.3 - 0.6]）。同时使用强心苷的患者更有可能接受第二代抗抑郁药物（比值比1.8 [95%置信区间1.2 - 2.1]）。在年龄和其他研究的患者特征方面，两个地区观察到相同的模式。
地区差异比个体患者特征对用药习惯差异的影响更大。为了改善抗抑郁药物的药物治疗，应更多地考虑相关患者特征。
