Sankaranarayanan Jayashri, Puumala Susan E
Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha, Nebraska 68198-6045, USA.
Curr Med Res Opin. 2007 Jun;23(6):1375-85. doi: 10.1185/030079907X187900.
There is limited research to acquaint clinicians and payers about antipsychotic use in psychiatric patients visiting United States (US) emergency departments (EDs). The study objective is to describe the epidemiology and compare characteristics of ED visits by adults > or = 18 years with psychiatric diagnoses and different types of antipsychotic.
Data for 2000-2004 adult ED visits were obtained from the National Hospital Ambulatory Medical Care Survey. Sample-weighted national estimates of (1) typical, (2) atypical, or (3) typical-atypical combination antipsychotic-associated psychiatric ED visits with 95% confidence intervals (CIs) were produced. Characteristics of the three psychiatric ED visit groups with antipsychotic mention, (prescribed, supplied, administered, ordered or continued) were analyzed retrospectively. Significant characteristics for atypical versus typical antipsychotic mention at visits were determined using multivariate logistic regression.
Adults made an estimated 26 million ED visits over the 5-year study period that resulted in a psychiatric diagnosis. Of 2 million (or 8%) of these psychiatric ED visits, 38, 55, and 8% mentioned typical, atypical, and combination antipsychotics respectively. From 2000 to 2004 there was an 8-, 3.5-, and 1.5-fold increase in ED visits with combination, atypical, and typical antipsychotics, respectively. The majority of antipsychotic-associated psychiatric ED visits were made by young adults less than 40 years old, Caucasians, needing urgent treatment, and reimbursed by public insurance. More combination-, and typical versus atypical antipsychotic-associated ED visits included a mention of medications for extrapyramidal symptoms (40%, 14% vs. 4%; p < 0.0001) and antianxiety medications (50%, 48% vs. 27%; p < 0.0001). More combination and atypical than typical antipsychotic-related ED visits had anticonvulsant (42%, 35% vs. 12%; p < 0.0001) and antidepressant mentions (31%, 42% vs. 11%; p < 0.0001). A diagnosis of depression (OR 3.2, 95% CI: 1.9-5.3; p < 0.001) or bipolar-disorder (OR 2.5, 95% CI: 1.3-5.0; p = 0.008), and the number of medications received (OR 1.4, 95% CI: 1.0-1.8; p = 0.034) significantly increased the likelihood of atypical versus typical antipsychotic mention at psychiatric ED visits.
Despite limitations of analyses with cross-sectional visit data, an increasing number of combination- and atypical antipsychotic-associated US adult ED visits depict the burden on the healthcare system. The associated characteristics of these visits deserve the attention of providers, and payers for cost-effective patient management.
关于美国急诊科（ED）就诊的精神科患者使用抗精神病药物的情况，可供临床医生和支付方了解的研究有限。本研究目的是描述18岁及以上患有精神疾病诊断且使用不同类型抗精神病药物的成年人到急诊科就诊的流行病学情况并比较其特征。
2000 - 2004年成人急诊科就诊数据来自国家医院门诊医疗调查。得出了（1）典型、（2）非典型或（3）典型 - 非典型联合使用抗精神病药物相关的精神科急诊科就诊的样本加权全国估计数及95%置信区间（CI）。对提及抗精神病药物（开具、提供、给药、医嘱或继续使用）的三个精神科急诊科就诊组的特征进行回顾性分析。使用多因素逻辑回归确定就诊时提及非典型与典型抗精神病药物的显著特征。
在为期5年的研究期间，成年人估计有2600万次急诊科就诊并被诊断患有精神疾病。在这200万次（或8%）精神科急诊科就诊中，分别有38%、55%和8%提及典型、非典型和联合使用抗精神病药物。从2000年到2004年，联合使用、非典型和典型抗精神病药物的急诊科就诊次数分别增加了8倍、3.5倍和1.5倍。大多数与抗精神病药物相关的精神科急诊科就诊是由40岁以下的年轻人、白种人进行的，他们需要紧急治疗，且由公共保险报销。更多联合使用以及典型与非典型抗精神病药物相关的急诊科就诊提到了锥体外系症状用药（40%、14%对4%；p < 0.0001）和抗焦虑药物（50%、48%对27%；p < 0.0001）。与典型抗精神病药物相关的急诊科就诊相比，更多联合使用和非典型抗精神病药物相关的急诊科就诊提到了抗惊厥药物（42%、35%对12%；p < 0.0001）和抗抑郁药物（31%、42%对11%；p < 0.0001）。抑郁症诊断（比值比3.2，95%置信区间：1.9 - 5.3；p < 0.001）或双相情感障碍（比值比2.5，95%置信区间：1.3 - 5.0；p = 0.008）以及接受药物的数量（比值比1.4，95%置信区间：1.0 - 1.8；p = 0.034）显著增加了精神科急诊科就诊时提及非典型与典型抗精神病药物的可能性。
尽管横断面就诊数据分析存在局限性，但美国越来越多与联合使用和非典型抗精神病药物相关的成人急诊科就诊显示出了医疗系统的负担。这些就诊的相关特征值得医疗服务提供者和支付方关注，以实现具有成本效益的患者管理。
