Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA.
Am J Manag Care. 2012 Aug 1;18(8):e307-14.
Recent research suggests that second generation antipsychotics (SGAs) may be used more often than clinically warranted. An intervention consisting of academic detailing and a prescriber survey was employed to encourage the reduction of newly prescribed on-patent SGAs.
Quasi-experimental quality improvement trial.
Academic detailing consisted of educational lectures and a pocket guide on the latest effectiveness, safety, and cost data for SGAs and first-generation antipsychotics. Detailing was coupled with a required 20-item survey of provider decision making completed prior to prescriptions for on-patent SGAs at a Veterans Health Administration medical center between October 2007 and May 2009. The survey identified the medication, treated diagnosis, comorbid psychiatric and medical diagnoses, reasons for the medication, prior medications, and provider professional status. The outcome was the number of new SGA prescriptions per month.
The sample included 2176 surveys. The Spearman correlation between the number of prescriptions and the intervention month (range = 1-18) was 0.25 (P = .31), indicating no reduction. The most common medication prescribed was quetiapine (55.8%). The distributions of diagnoses were fairly even among schizophrenia, bipolar disorder, other affective disorders, and posttraumatic stress disorder (17.0, 28.2, 25.8, and 20.4%, respectively). The 3 most common reasons for prescribing an SGA were to improve efficacy (49.8%), reduce side effects (29.1%), and increase sleep or sedation (34.5%).
Academic detailing coupled with a provider survey did not decrease the rate of new prescriptions for on-patent SGAs. Reasons for prescribing SGAs were not consistent with recent research findings regarding efficacy and side effects.
最近的研究表明，第二代抗精神病药物（SGAs）的使用可能超出了临床需要。本研究采用学术细节和处方医生调查干预措施，以鼓励减少新处方的专利 SGAs。
准实验性质量改进试验。
学术细节包括教育讲座和口袋指南，介绍 SGA 和第一代抗精神病药物的最新效果、安全性和成本数据。在 2007 年 10 月至 2009 年 5 月期间，退伍军人健康管理局医疗中心的医生在为专利 SGAs 开处方之前，必须完成一项关于处方决策的 20 项调查。该调查确定了药物、治疗诊断、合并的精神和医学诊断、用药原因、之前的药物和医生的专业状况。结果是每月新的 SGA 处方数量。
样本包括 2176 项调查。处方数量与干预月份（范围= 1-18）之间的 Spearman 相关系数为 0.25（P =.31），表明没有减少。最常开的药物是喹硫平（55.8%）。诊断的分布在精神分裂症、双相情感障碍、其他情感障碍和创伤后应激障碍（分别为 17.0%、28.2%、25.8%和 20.4%）之间相当均匀。开 SGA 的三个最常见原因是提高疗效（49.8%）、减少副作用（29.1%）和增加睡眠或镇静（34.5%）。
学术细节与处方医生调查相结合，并没有降低新处方专利 SGAs 的速度。开 SGA 的原因与最近关于疗效和副作用的研究结果不一致。
