Pavlin Julie A, Murdock P, Elbert E, Milliken C, Hakre S, Mansfield J, Hoge C
Department of Field Studies, Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD 20910, USA.
MMWR Suppl. 2004 Sep 24;53:166-72.
The Walter Reed Army Institute of Research used the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) to conduct population-based behavioral health surveillance among military-health-system beneficiaries. The study analyzed the effectiveness of using prescribing patterns of psychotropic medications to monitor changes in a community's behavioral health status.
The objectives of this study were to 1) determine the feasibility of tracking psychiatric illnesses by monitoring prescriptions for psychiatric medications; 2) assess how often psychiatric medications are prescribed for patients with no record of psychiatric illness; 3) determine at what types of clinics these medications are prescribed most often and what other diagnoses are attributed to these patients; and 4) analyze data for potential changes in the population's mental health after high-stress events.
Correlation analysis and calculations of sensitivity and specificity were used to determine how well prescription medications correlate with outpatient diagnoses and how well they serve as proxies for outpatient diagnoses. A descriptive analysis was conducted of the types of clinics (e.g., primary care, behavioral health, or other specialty clinics) treating patients and the associated percentage of concurrence between prescriptions and diagnostic codes.
In military treatment facilities, a diagnosis of depression or anxiety correlated significantly (r = 0.82) with antidepressant or anxiolytic prescriptions. Sensitivity of prescriptions when compared with outpatient visits was 0.76, and specificity was 0.94. Among those patients who visited a primary care clinic either the day before or the same day as an antidepressant or anxiolytic prescription was filled, 60.1% did not receive a diagnosis of any mental health disorder. Behavioral health clinics had the highest correlation between diagnoses and prescriptions; specialty clinics had the lowest.
Behavioral health trends in a population can be monitored by automated analysis of prescribing patterns alone. This method might be a rapid indicator of needed mental health interventions after acute stress-inducing events and be more sensitive than tracking diagnoses alone.
沃尔特·里德陆军研究所利用社区疫情早期预警电子监测系统（ESSENCE）对军事医疗系统受益人群进行基于人群的行为健康监测。该研究分析了利用精神药物处方模式监测社区行为健康状况变化的有效性。
本研究的目的是：1）通过监测精神药物处方来确定追踪精神疾病的可行性；2）评估为无精神疾病记录的患者开具精神药物的频率；3）确定这些药物最常在哪类诊所开具以及这些患者还有哪些其他诊断；4）分析高压力事件后人群心理健康的潜在变化数据。
采用相关性分析以及敏感度和特异度计算，以确定处方药与门诊诊断的关联程度以及它们作为门诊诊断替代指标的效果。对治疗患者的诊所类型（如初级保健、行为健康或其他专科诊所）以及处方与诊断代码之间的相关百分比进行了描述性分析。
在军事治疗机构中，抑郁症或焦虑症诊断与抗抑郁药或抗焦虑药处方之间存在显著相关性（r = 0.82）。与门诊就诊相比，处方的敏感度为0.76，特异度为0.94。在开具抗抑郁药或抗焦虑药处方的前一天或当天就诊初级保健诊所的患者中，60.1%未被诊断出患有任何精神健康障碍。行为健康诊所的诊断与处方之间的相关性最高；专科诊所的相关性最低。
仅通过对处方模式的自动分析就可以监测人群中的行为健康趋势。这种方法可能是急性应激事件后所需心理健康干预的快速指标，并且比单纯追踪诊断更敏感。
