Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec.
Can J Psychiatry. 2013 Aug;58(8):456-65. doi: 10.1177/070674371305800804.
Though high discontinuation rates for antipsychotics (APs) by patients with schizophrenia are frequently reported, the percentage of patients receiving pharmaceutical treatment for schizophrenia in routine practice in accordance with international clinical guidelines is unknown. Further, it is unknown if these rates are influenced by levels of neighbourhood deprivation or by a patient's age or sex. Our study aims to investigate if inequalities in AP treatment could be observed between patients living in neighbourhoods with the highest levels of material and social deprivation and those with the lowest deprivation levels, between patients from different age groups, or between men and women.
We conducted a secondary analysis of medical-administrative data of a cohort of adult patients in the province of Quebec with a medical contact for schizophrenia in a 2-year period (2004-2005). We assessed the proportion of patients that filled at least 1 prescription for an AP and received adequate pharmaceutical treatment, defined as being in possession of APs at least 80% of the time as outpatients during a 2-year follow-up period.
Among the 30 544 study patients, 88.5% filled at least 1 prescription for an AP, and 67.5% of the treated patients received adequate treatment. Though no clinically significant differences were observed by deprivation or sex, younger age was associated with lower proportions of patients receiving adequate treatment (46% of treated patients aged between 18 and 29 years, compared with 72% aged between 30 and 64 years, and 77% aged 65 years and over).
In Quebec's routine practice, over 70% of treated patients aged 30 and over received adequate pharmacological treatment, regardless of sex or neighbourhood socioeconomic status. In contrast, in patients aged between 18 and 29 years this percentage was 47%. This is a discouraging finding, especially because optimal treatment in the early phase of disease is reported to result in the best long-term outcomes.
尽管经常有报道称精神分裂症患者中断抗精神病药物（APs）治疗的比例很高，但在常规实践中，根据国际临床指南，接受精神分裂症药物治疗的患者比例尚不清楚。此外，尚不清楚这些比例是否受到邻里贫困程度或患者年龄或性别的影响。我们的研究旨在调查是否可以观察到居住在物质和社会剥夺程度最高的社区和剥夺程度最低的社区的患者之间、不同年龄组的患者之间或男性和女性之间的 AP 治疗不平等现象。
我们对魁北克省的一个成年患者队列的医疗管理数据进行了二次分析，该队列在 2 年内（2004-2005 年）有精神分裂症的医疗接触。我们评估了至少开具 1 份 AP 处方并接受适当药物治疗的患者比例，定义为在 2 年随访期间，作为门诊患者至少有 80%的时间拥有 AP。
在 30544 名研究患者中，88.5%的患者至少开具了 1 份 AP 处方，67.5%的治疗患者接受了适当的治疗。尽管在贫困程度或性别方面没有观察到明显的临床差异，但年龄较小与接受适当治疗的患者比例较低有关（18-29 岁年龄组的治疗患者中，有 46%接受了适当治疗，而 30-64 岁年龄组为 72%，65 岁及以上年龄组为 77%）。
在魁北克的常规实践中，超过 70%的 30 岁及以上的治疗患者接受了适当的药物治疗，无论其性别或邻里社会经济地位如何。相比之下，18-29 岁年龄组的这一比例为 47%。这是一个令人沮丧的发现，尤其是因为据报道，在疾病早期进行最佳治疗会带来最佳的长期结果。
