Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, USA.
Psychiatr Serv. 2009 Dec;60(12):1595-602. doi: 10.1176/ps.2009.60.12.1595.
This study sought to identify and characterize rates of clinically questionable prescribing in New York State.
As part of a quality improvement initiative, 34 national psychopharmacology experts identified a set of questionable prescribing practices recognizable from pharmacy claims data. Indicators of such practices were applied to Medicaid claims data for 217,216 beneficiaries in New York State who had an active psychotropic prescription on April 1, 2008.
A total of 156,103 (72%) of these beneficiaries had one or more continuing (>90 days) prescriptions for a psychotropic. About 10% of adults were prescribed four or more psychotropics concurrently, and 13% of children and 2% of older adults were prescribed three or more concurrently. Prescribing an antipsychotic with a moderate-to-high risk of causing metabolic abnormalities approached 50% (46%) among individuals who had existing cardiometabolic conditions. Among beneficiaries prescribed second-generation antipsychotics with a moderate-to-high risk of causing metabolic abnormalities, over half (60%) had not received a metabolic screening test in the past year. Among women of reproductive age prescribed mood stabilizers, over one-quarter (30%) were prescribed a valproic acid-based formulation despite its potential for teratogenicity. Only 2% of youths under age 18 were prescribed benzodiazepines; however, about half (48%) had trials over 90 days' duration.
Examination of pharmacy claims from Medicaid beneficiaries in New York State indicated that prescribing practices deemed clinically questionable by pharmacology experts are common. Aggregated pharmacy claims data can identify such practices, and reviews of these data can be a core component of efforts to improve prescribing practices.
本研究旨在确定并描述纽约州临床有疑问的处方率。
作为一项质量改进倡议的一部分，34 名国家精神药理学专家确定了一组可从药房理赔数据中识别出的有疑问的处方实践。这些做法的指标适用于纽约州 217216 名有活跃精神药物处方的医疗补助受益人的理赔数据，这些人在 2008 年 4 月 1 日有一个有效的精神药物处方。
这些受益人中有 156103 人（72%）有一个或多个持续（>90 天）的精神药物处方。大约 10%的成年人同时开了四种或四种以上的精神药物，13%的儿童和 2%的老年人同时开了三种或三种以上的精神药物。在有既有心脏代谢疾病的个体中，处方一种中等至高度可能导致代谢异常的抗精神病药物的情况接近 50%（46%）。在被处方中等至高度可能导致代谢异常的第二代抗精神病药物的受益人中，超过一半（60%）在过去一年中没有接受过代谢筛查测试。在开有心境稳定剂的育龄妇女中，超过四分之一（30%）尽管丙戊酸有潜在致畸性，但仍开了丙戊酸钠制剂。在 18 岁以下的青少年中，只有 2%的人开了苯二氮䓬类药物；然而，大约一半（48%）的人服用了超过 90 天的药物。
对纽约州医疗补助受益人的药房理赔数据进行检查表明，被药理学专家认为临床有疑问的处方做法很常见。汇总的药房理赔数据可以识别出这些做法，对这些数据的审查可以成为改善处方做法努力的核心组成部分。
