Prueksaritanond Somjit, Tubtimtes Saisunee, Pumkompol Taratip, Sukying Chakrit
Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2009 Feb;92(2):266-72.
Primary care physicians are playing an increasing role in providing mental health care. Psychotropic drugs prescription may be used evaluate primary care physicians in treating and caring for mental disorders.
Evaluate the prevalence, pattern, and rational of psychotropic drugs prescribing by primary care physicians in a tertiary care university hospital.
Four thousand four hundred ninety nine records of subjects aged 15 years old and older who received psychotropic drugs from a computer database between August 1, 2004 and January 31, 2005 were analyzed. Through systemic random sampling, rational drugs use from medical records of 575 patients was assessed.
The rate ofpsychotropic drugs prescribing was 9.04%, which was found to increase with increasing age and female patients. Benzodiazepines were the most commonly prescribed (88.9%), followed by antidepressants (9.5%), and antipsychotics (1.1%). Lorazepam (34.7%), alprazolam (28.7%), and diazepam (19.2%) were the top three benzodiazepines prescribed. Polypharmacy was found at 13.4%. The drugs were prescribed for psychological conditions (74.8%; 51.7% by diagnosis and 23.1% by symptoms and/or signs), musculoskeletal disorder of the neck or spine (11.8%), chronic pain disorder (11.8%), and undocumented (1.6%). The psychological problems per se, physical problems per se, and the combination between psychological and physical problems were 21.6, 56.7, and 21.7% respectively. Insomnia, tension headache, and anxiety were the top three most common psychological diagnosis while hypertension, dyslipidemia, and low back pain were the top three most physical diagnosis. The long-term psychotropic drug use (2 months and above) comprised 25.9%. The follow up length ranged from less than 1 week to 24 weeks. The follow-up schedule was made in 73.9%. An actual return visit was 61.6%. Therefore, 12.3% was lost to follow up.
The present study illustrates the prevalence, pattern, and rational use of psychotropic medications in primary care of a tertiary university hospital. Intermediate-acting benzodiazepines were the most commonly prescribed. They were prescribed not only for mental but also for musculoskeletal and chronic pain disorders. A quarter of the patients received psychotropic drugs as well as long-term medications without diagnosis. Some patients were put on psychotropic drugs combination. To optimize patient outcomes, a diagnosis should be encouraged The long-term use and polypharmacy should be minimized. The quality and appropriateness of prescribed medication should be part of a future research project.
基层医疗医生在提供精神卫生保健方面发挥着越来越重要的作用。精神药物处方可用于评估基层医疗医生对精神障碍的治疗和护理情况。
评估一所三级大学医院中基层医疗医生开具精神药物的患病率、模式及合理性。
分析了2004年8月1日至2005年1月31日期间从计算机数据库中获取的4499例15岁及以上接受精神药物治疗患者的记录。通过系统随机抽样，评估了575例患者病历中的合理用药情况。
精神药物处方率为9.04%，发现该率随年龄增长和女性患者增加而升高。苯二氮䓬类药物是最常开具的（88.9%），其次是抗抑郁药（9.5%）和抗精神病药（1.1%）。劳拉西泮（34.7%）、阿普唑仑（28.7%）和地西泮（19.2%）是开具最多的三种苯二氮䓬类药物。发现联合用药率为13.4%。这些药物用于心理状况（74.8%；51.7%根据诊断，23.1%根据症状和/或体征）、颈部或脊柱肌肉骨骼疾病（11.8%）、慢性疼痛疾病（11.8%）以及未记录情况（1.6%）。单纯心理问题、单纯身体问题以及心理和身体问题的组合分别占21.6%、56.7%和21.7%。失眠、紧张性头痛和焦虑是最常见的三种心理诊断，而高血压、血脂异常和腰痛是最常见的三种身体诊断。长期使用精神药物（2个月及以上）占25.9%。随访时长从不到1周至24周不等。73.9%制定了随访计划。实际回访率为61.6%。因此，12.3%失访。
本研究阐明了一所三级大学医院基层医疗中精神药物的患病率、模式及合理使用情况。中效苯二氮䓬类药物是最常开具的。它们不仅用于精神疾病，还用于肌肉骨骼和慢性疼痛疾病。四分之一的患者在未明确诊断的情况下接受了精神药物以及长期药物治疗。一些患者使用了精神药物联合治疗。为优化患者治疗效果，应鼓励明确诊断。应尽量减少长期用药和联合用药。处方药物的质量和合理性应成为未来研究项目的一部分。
