Center for Neuropsychiatric Schizophrenia Research, Copenhagen University Hospital, Psychiatric Center Glostrup, Nordre Ringvej 29-67, DK-2600 Glostrup, Denmark.
J Clin Psychiatry. 2010 Nov;71(11):1457-64. doi: 10.4088/JCP.09m05270yel. Epub 2010 Oct 19.
The pharmacologic treatment of schizophrenia is characterized by excessive use of antipsychotic polypharmacy, which reflects a gap between evidence and practice. The aim of the present study was to investigate regional differences in treatment setting characteristics and in physician and nurse attitudes toward antipsychotic polypharmacy and clinical guidelines.
Cross-sectional postal questionnaire survey directed to physicians and nurses at 2 pairs of treatment settings in Denmark, characterized by low and high prevalence of antipsychotic polypharmacy, respectively. The questionnaire investigation was conducted during November 2007 to February 2008.
Satisfactory response rates were obtained (physicians: 93%; nurses: 87%). The treatment settings with low use of antipsychotic polypharmacy were characterized by raised knowledge/awareness of local antipsychotic treatment guidelines (P = .02 for physicians; P = .01 for nurses). Among physicians, these settings were also characterized by an elevated confidence in these guidelines (P = .01), frequent local educational activities (P < .0001), and increased recent involvement in research (P = .01). Among nurses, a perception of an overwhelming work load (P = .01) and time pressure (P = .003) was significantly more prevalent in treatment settings with high rates of antipsychotic coprescribing, as was the belief in the benefit of antipsychotic polypharmacy augmentation (P = .001).
Albeit no causal relationships can be inferred from this cross-sectional observational study, we recommend the furtherance of a treatment environment characterized by easily accessible clinical guidelines, frequent academic activities, and an unruffled atmosphere.
精神分裂症的药物治疗特点是过度使用抗精神病药联合治疗，这反映了证据与实践之间的差距。本研究旨在调查治疗环境特征以及医生和护士对抗精神病药联合治疗和临床指南的态度方面的区域差异。
这是一项在丹麦 2 对治疗环境中进行的横断面邮寄问卷调查，这些治疗环境的特点是抗精神病药联合治疗的使用频率较低和较高。问卷调查于 2007 年 11 月至 2008 年 2 月进行。
获得了令人满意的回复率（医生：93%；护士：87%）。抗精神病药联合治疗使用率较低的治疗环境的特点是对当地抗精神病治疗指南的了解/认识提高（医生：P =.02；护士：P =.01）。在这些环境中，医生对抗精神病药联合治疗指南的信心也有所提高（P =.01），经常开展当地的教育活动（P <.0001），并且最近参与了研究（P =.01）。在护士中，高抗精神病药合并处方率治疗环境中，工作负荷过重（P =.01）和时间压力（P =.003）的感觉更为普遍，对抗精神病药联合治疗的益处的信念也更为普遍（P =.001）。
尽管从这项横断面观察性研究中不能推断出任何因果关系，但我们建议进一步营造一个以易于获取的临床指南、频繁的学术活动和宁静的氛围为特点的治疗环境。
