Xue Qiuji, Xiong Xianjun, Feng Yi, Yao Lan, Chen Shanquan, Xiang Li
aSchool of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan bChina Health Insurance Research Association, Beijing, People's Republic of China.
Int Clin Psychopharmacol. 2014 Sep;29(5):288-95. doi: 10.1097/YIC.0000000000000024.
Medication is critical in schizophrenia therapy, and prescription patterns have changed considerably over the past 20 years in China. This study attempts to evaluate the prescription patterns of antipsychotics for inpatients with schizophrenia in China and to identify factors influencing these patterns. Claims data of inpatients diagnosed with schizophrenia in 2010 were derived from the reimbursement database of Wuhan and Wuxi. A total of 5251 inpatients received antipsychotic medications, of whom 29.0% received second-generation antipsychotics apart from clozapine (SGAs#), 13.7% received clozapine (CLO), 13.5% received first-generation antipsychotics (FGAs), 43.8% received at least both drug classes, and 5.1% used FGAs, CLO as well as SGAs#. Multinomial logistic regression for 2904 identified inpatients showed that factors of drug reimbursement policy, duration of hospitalization, age group, and municipality were statistically significant in antipsychotic medication. Drug list B and the 25-45 age group presented a significant relationship with SGAs# prescription (FGAs vs. SGAs#). Furthermore, the 12-30-day duration of hospitalization and the 25-45 age group showed a significant relationship with SGAs# prescription (CLO vs. SGAs#). Socioeconomic factors such as health insurance policies, especially reimbursement policy of drugs and payment system, as well as mental health resource distribution are important in antipsychotic prescription in China.
药物治疗在精神分裂症治疗中至关重要，在过去20年里中国的处方模式发生了很大变化。本研究旨在评估中国精神分裂症住院患者的抗精神病药物处方模式，并确定影响这些模式的因素。2010年诊断为精神分裂症的住院患者的理赔数据来自武汉和无锡的报销数据库。共有5251名住院患者接受了抗精神病药物治疗，其中29.0%接受了除氯氮平之外的第二代抗精神病药物（非氯氮平第二代抗精神病药物），13.7%接受了氯氮平（CLO），13.5%接受了第一代抗精神病药物（FGAs），43.8%至少接受了这两类药物，5.1%使用了第一代抗精神病药物、氯氮平以及非氯氮平第二代抗精神病药物。对2904名确定的住院患者进行的多项逻辑回归分析表明，药物报销政策、住院时间、年龄组和城市等因素在抗精神病药物治疗中具有统计学意义。药品目录B和25 - 45岁年龄组与非氯氮平第二代抗精神病药物处方（第一代抗精神病药物与非氯氮平第二代抗精神病药物）呈现显著关系。此外，12 - 30天的住院时间和25 - 45岁年龄组与非氯氮平第二代抗精神病药物处方（氯氮平与非氯氮平第二代抗精神病药物）呈现显著关系。医疗保险政策等社会经济因素，尤其是药品报销政策和支付系统，以及精神卫生资源分配在中国抗精神病药物处方中很重要。
