接受符合指南的重度抑郁症药物治疗：对门诊和住院医疗服务使用的影响。

Receiving guideline-concordant pharmacotherapy for major depression: impact on ambulatory and inpatient health service use.

作者信息

Sewitch Maida J, Blais Régis, Rahme Elham, Bexton Brian, Galarneau Sophie

机构信息

Department of Medicine, McGill University, Montreal, Quebec.

出版信息

Can J Psychiatry. 2007 Mar;52(3):191-200. doi: 10.1177/070674370705200311.

DOI:10.1177/070674370705200311

PMID:17479528

Abstract

OBJECTIVE

This study aimed to determine the associations between guideline-concordant pharmacotherapy for depression and the use of health services in the year following diagnosis.

METHOD

This population-based, retrospective cohort study examined Quebec drug plans between 1999 and 2002. We included beneficiaries aged 18 to 64 years who were newly diagnosed with an episode of depression by primary care physicians and psychiatrists between October 1, 2000, and March 31, 2001, and who made at least one psychotropic pharmacy claim within 31 days of diagnosis. We defined guideline concordance as the receipt of recommended medication, starting dosage, and treatment duration as defined by the Canadian Network for Mood and Anxiety Treatments guidelines. We measured outcomes on use of ambulatory (number of visits to prescribing physician, other physicians, or emergency departments) and inpatient (hospitalization) services.

RESULTS

There were 2742 patients (mean age 42 years; 64% female patients) who met the study criteria. Of the 2047 (75%) patients to whom an antidepressant was dispensed, 1958 (71%) received a recommended first-line medication, 1297 (63%) received a recommended starting dosage, and 304 (15%) received a recommended duration. According to the 3 criteria, only 8% were treated appropriately; 21% received benzodiazepines rather than antidepressants. There were 2 median visits (inferquartile range [IQR] 1 to 3) to prescribing physicians, 0 visits (IQR 0 to 1) to other physicians, and 0 visits (IQR 0 to 0) to emergency departments; 497 (18%) patients were hospitalized. In separate multivariate models for repeated measures, recommended first-line medication, dosage, and duration were associated with more prescribing physician visits. Recommended first-line medication reduced the odds of hospitalization.

CONCLUSION

Guideline concordance was associated with more visits to prescribing physicians and lower odds of hospitalization.

摘要

目的

本研究旨在确定抑郁症指南一致性药物治疗与诊断后一年内医疗服务利用之间的关联。

方法

这项基于人群的回顾性队列研究考察了1999年至2002年期间魁北克的药物计划。我们纳入了年龄在18至64岁之间的受益人，他们在2000年10月1日至2001年3月31日期间被初级保健医生和精神科医生新诊断为抑郁症发作，并且在诊断后31天内至少有一次精神药物药房报销记录。我们将指南一致性定义为按照加拿大情绪和焦虑治疗网络指南所定义的接受推荐药物、起始剂量和治疗持续时间。我们测量了门诊（就诊于开处方医生、其他医生或急诊科的次数）和住院（住院治疗）服务的使用情况。

结果

有2742名患者（平均年龄42岁；64%为女性患者）符合研究标准。在配发了抗抑郁药的2047名（75%）患者中，1958名（71%）接受了推荐的一线药物，1297名（63%）接受了推荐的起始剂量，304名（15%）接受了推荐的治疗持续时间。根据这三项标准，只有8%的患者得到了适当治疗；21%的患者接受的是苯二氮䓬类药物而非抗抑郁药。患者就诊于开处方医生的次数中位数为2次（四分位间距[IQR]为1至3次），就诊于其他医生的次数为0次（IQR为0至1次），就诊于急诊科的次数为0次（IQR为0至0次）；497名（18%）患者住院治疗。在重复测量的单独多变量模型中，推荐的一线药物、剂量和持续时间与更多次就诊于开处方医生相关。推荐的一线药物降低了住院几率。