Ashcroft Darren M, Frischer Martin, Lockett Joanne, Chapman Stephen R
Department of Medicines Management, Keele University, Keele, Staffordshire ST5 5BG, UK.
Pharmacoepidemiol Drug Saf. 2002 Jun;11(4):285-9. doi: 10.1002/pds.703.
Side-effects from conventional antipsychotic drugs, in particular extrapyramidal side-effects, limit their use for some patients, lead to non-compliance and may adversely affect the quality of life of others. Newer, more expensive, 'atypical' antipsychotics have been developed in attempts to address these problems, although debate about the most appropriate role for these medications remains.
To examine variations in prescribing of the 'atypical' antipsychotics in primary care, over a 5-year period.
All 13 health authorities within the West Midlands region.
Cross-sectional analysis of prescribing analysis and cost (PACT) data for atypical antipsychotic drugs (amisulpride, clozapine, olanzapine, risperidone, sertindole, and zotepine) was performed using one-way analysis of variance. To test whether the differences reflected variation in local population need, the prescribing data were adjusted using Mental Illness Needs Index scores. Regression analysis was used to examine the relationship between the overall levels of prescribing and local population need.
The total volume of prescribing of atypical antipsychotic drugs in primary care increased nearly six-fold from 1996/97 to 2000/01 in the West Midlands region. Olanzapine was the most commonly prescribed drug during 1999/2000, accounting for 45% of defined daily doses, while risperidone accounted for 38% of the total. In 1996/97, a four-fold variation in rates of atypical antipsychotic prescribing between health authorities was found, compared with a three-fold variation in 2000/01, after adjusting for measures of local population need.
There has been a substantial increase in the prescription of atypical antipsychotics in primary care over the last 5 years, but the rate of increase has varied widely between health authorities. Further studies are needed to determine the factors that have led to these differences in uptake, and the likely impact of national guidance on future prescribing patterns.
传统抗精神病药物的副作用，尤其是锥体外系副作用，限制了其在某些患者中的使用，导致患者不依从治疗，并且可能对其他患者的生活质量产生不利影响。为了解决这些问题，人们研发了更新、更昂贵的“非典型”抗精神病药物，尽管关于这些药物最合适的作用仍存在争议。
研究在5年期间基层医疗中“非典型”抗精神病药物处方的变化情况。
西米德兰兹地区的所有13个卫生当局。
使用单因素方差分析对非典型抗精神病药物（氨磺必利、氯氮平、奥氮平、利培酮、舍吲哚和佐替平）的处方分析和成本（PACT）数据进行横断面分析。为了检验这些差异是否反映了当地人群需求的变化，使用精神疾病需求指数得分对处方数据进行了调整。回归分析用于研究处方总体水平与当地人群需求之间的关系。
在西米德兰兹地区，基层医疗中“非典型”抗精神病药物的处方总量从1996/97年到2000/01年增加了近六倍。1999/2000年期间，奥氮平是最常用的药物，占规定日剂量的45%，而利培酮占总量的38%。在1996/97年，调整当地人群需求指标后，各卫生当局之间非典型抗精神病药物处方率有四倍的差异，而在2000/01年有三倍的差异。
在过去5年中，基层医疗中非典型抗精神病药物的处方量大幅增加，但各卫生当局之间的增长速度差异很大。需要进一步研究以确定导致这些使用差异的因素，以及国家指南对未来处方模式可能产生的影响。
