Huang Weng-Foung, Lai I-Ching
Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taipei, Taiwan.
Drugs Aging. 2005;22(11):957-65. doi: 10.2165/00002512-200522110-00005.
To explore prescription patterns and determinants of sleep-related medications prescribed to elderly outpatients with insomnia in Taiwan.
This cross-sectional study was based on 2001 annual outpatient claims data released by the Bureau of National Health Insurance in Taiwan. The claims data of each physician consultation were extracted and merged in one claim file. International Classification of Diseases (9th Edition)-Clinical Modification codes, patient's demographics, physician's specialty, the medical institution code and the content of pharmaceutical prescription constituted a file. Patients were included if they were: (i) > or =65 years of age; and (ii) coded as having 'insomnia'.
Elderly insomniacs made up 216,994 of the 1,000,193 outpatient claim files we surveyed. Patients had a mean age of 74.33 years, and the sex distribution was nearly equal. Based on the data above, 11.14% of the elderly had been diagnosed as having 'insomnia' for the year 2001. This population preferred primary-care clinics over hospital-ambulatory departments; patients most frequently sought medical help from internal medicine specialists. The most popular sleep medication was lorazepam, followed by zolpidem. The first-choice off-label drug used to treat insomnia was trazodone. Hypnotics, sedatives and anxiolytics were prescribed 12.6 times more frequently than off-label used drugs. When treating insomnia with an off-label drug, physicians usually prescribed a therapeutic dosage much lower than that recommended in the package insert. Choice of sleep medication and off-label drug were most often influenced by physician specialty. Off-label prescriptions were common but not prevalent. Choice of hypnotic or sedative-anxiolytic was related to how long the drug acted and how much it cost; choice of off-label drug was related to physicians' familiarity with specific drugs and patients' characteristics. Concomitant anxiety or depression was significantly associated with higher consumption of hypnotics.
Benzodiazepines and newer non-benzodiazepine hypnotics are still the most frequently used drugs for treating insomnia in the elderly in Taiwan. Elderly patients with concomitant anxiety or depression consumed more hypnotics. Further studies conducted over several years are needed to identify trends in the pharmacological treatment of insomnia.
探讨台湾老年失眠门诊患者睡眠相关药物的处方模式及影响因素。
本横断面研究基于台湾国民健康保险局发布的2001年年度门诊索赔数据。提取每次医师诊疗的索赔数据并合并到一个索赔文件中。国际疾病分类（第9版）-临床修订版编码、患者人口统计学信息、医师专业、医疗机构代码和药物处方内容构成一个文件。纳入标准为：（i）年龄≥65岁；（ii）编码为患有“失眠”。
在我们调查的1,000,193份门诊索赔文件中，老年失眠患者有216,994例。患者平均年龄为74.33岁，性别分布几乎相等。根据上述数据，2001年11.14%的老年人被诊断患有“失眠”。该人群更倾向于基层医疗诊所而非医院门诊部；患者最常向内科专家寻求医疗帮助。最常用的助眠药物是劳拉西泮，其次是唑吡坦。用于治疗失眠的首选非标签药物是曲唑酮。催眠药、镇静药和抗焦虑药的处方频率比非标签使用药物高12.6倍。使用非标签药物治疗失眠时，医师通常开具的治疗剂量远低于药品说明书中推荐的剂量。助眠药物和非标签药物的选择最常受医师专业影响。非标签处方很常见但并不普遍。催眠药或镇静抗焦虑药的选择与药物作用时间和成本有关；非标签药物的选择与医师对特定药物的熟悉程度和患者特征有关。合并焦虑或抑郁与更高的催眠药消费量显著相关。
苯二氮䓬类药物和新型非苯二氮䓬类催眠药仍是台湾老年失眠患者最常用的治疗药物。合并焦虑或抑郁的老年患者使用更多的催眠药。需要进行数年的进一步研究以确定失眠药物治疗的趋势。
