Blanco Carlos, Goodwin Renee D, Liebowitz Michael R, Schmidt Andrew B, Lewis-Fernández Roberto, Olfson Mark
Departments of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, New York 10032, USA.
Med Care. 2004 Dec;42(12):1242-6. doi: 10.1097/00005650-200412000-00011.
We sought to examine trends in the medication management of panic disorder from a nationally representative sample of visits to psychiatrists and primary care physicians in office-based practice.
We analyzed physician-reported data from the 1992-1995 and 1996-1999 National Ambulatory Medical Care Survey, focusing on medication management of panic disorder by primary care physicians and psychiatrists. Rates for which doctors prescribed medication for patients with a diagnosis of panic disorder were compared over the course of time to identify changes in medication management between physician groups. We used logistic regression models to identify predictors of medication prescription, adjusting for the presence of other covariates.
Both physician groups prescribed a psychotropic medication to a majority of patients for panic disorder in each time period. In 1992-1995, primary care physicians were less likely than psychiatrists to prescribe psychotropic medications. This difference was not evident in 1996-1999. The prescribing of benzodiazepines was common in both physician groups and time periods. Overall rates of psychotropic prescriptions by physician groups converged over time, although no single drug class accounted individually for the convergence.
In recent years, changes in the medication management of patients with panic disorder by primary care physicians have resulted in greater similarity with the pharmacologic treatment of panic disorder provided in psychiatric practice.
我们试图通过在门诊实践中对精神病医生和初级保健医生进行全国代表性抽样调查,来研究惊恐障碍药物治疗管理的趋势。
我们分析了1992 - 1995年和1996 - 1999年全国门诊医疗调查中医生报告的数据,重点关注初级保健医生和精神病医生对惊恐障碍的药物治疗管理。比较不同时间段内医生为诊断为惊恐障碍的患者开药的比例,以确定不同医生群体之间药物治疗管理的变化。我们使用逻辑回归模型来确定药物处方的预测因素,并对其他协变量的存在进行调整。
在每个时间段,两个医生群体都为大多数惊恐障碍患者开了精神药物。在1992 - 1995年,初级保健医生比精神病医生开精神药物的可能性小。这种差异在1996 - 1999年并不明显。苯二氮䓬类药物的处方在两个医生群体和两个时间段都很常见。随着时间的推移,医生群体的精神药物处方总体比例趋于一致,尽管没有单一药物类别单独导致这种趋同。
近年来,初级保健医生对惊恐障碍患者药物治疗管理的变化,使其在药物治疗上与精神病学实践中对惊恐障碍的药物治疗更为相似。