Sun FangFang, Stock Eileen M, Copeland Laurel A, Zeber John E, Ahmedani Brian K, Morissette Sandra B
FangFang Sun, M.S., is Health Services Researcher, Center for Applied Health Research, Temple, TX. Eileen M. Stock, Ph.D., is Research Scientist, Center for Applied Health Research, and Assistant Professor, College of Medicine, Texas A&M Health Sciences Center, Bryan. Laurel A. Copeland, Ph.D., is Interim Associate Chief of Staff of Research, Central Texas Veterans Health Care System, Temple, and Associate Director, Center for Applied Health Research, and Associate Professor, College of Medicine, Texas A&M Health Sciences Center. John E. Zeber, Ph.D., is Co-Director, Health Outcomes Core (jointly sponsored by Central Texas Veterans Health Care System and Scott & White Healthcare), Temple, and Associate Professor, College of Medicine, Texas A&M Health Sciences Center. Brian K. Ahmedani, Ph.D., LMSW, is Research Scientist, Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI. Sandra B. Morissette, Ph.D., is Assessment Core Chief, Veterans Affairs VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, and Associate Professor, College of Medicine, Texas A&M Health Sciences Center.
Am J Health Syst Pharm. 2014 May 1;71(9):728-38. doi: 10.2146/ajhp130471.
Patterns of pharmacologic treatment in U.S. outpatients with schizophrenia across multiple health care settings were investigated.
Antipsychotic drug utilization by patients with schizophrenia and related disorders was analyzed using data on 119,662 patients served by the Veterans Affairs (VA) health care system in fiscal years 2005-09, data on 5,440 enrollees in two health maintenance organizations (HMOs) in 2002-09, and National Ambulatory Medical Care Survey (NAMCS) data reflecting the experience of 17.6 million U.S. residents seeking care outside federal systems during the same eight-year period. Polypharmacy was defined as the use of more than one antipsychotic agent during one year (in the VA sample) or one week (in the HMO and NAMCS samples). The association of polypharmacy with hospital admissions was assessed via multivariable logistic regression.
Rates of antipsychotic use in the VA sample ranged from 74% to 78%, with lower and more variable rates in the NAMCS sample (69-84%) and the HMO sample (22-67%). VA patients were found to have lower polypharmacy rates (20-22%) than patients in the HMO and NAMCS samples (19-31%). In all samples evaluated, polypharmacy was associated with an increased likelihood of hospital admission (odds ratio range, 1.4-2.4).
A multisystem study revealed that antipsychotic use among patients with schizophrenia varied substantially among health care systems and that nearly one fifth of patients with schizophrenia or other psychotic disorders in most of the health care systems experienced antipsychotic polypharmacy.
研究美国精神分裂症门诊患者在多种医疗环境下的药物治疗模式。
利用退伍军人事务部（VA）医疗系统在2005 - 09财年为119,662名患者提供服务的数据、两个健康维护组织（HMO）在2002 - 09年的5440名参保者的数据以及国家门诊医疗调查（NAMCS）数据（反映了同一八年期间1760万在联邦系统外寻求治疗的美国居民的情况），分析精神分裂症及相关疾病患者的抗精神病药物使用情况。联合用药定义为在一年期间（VA样本）或一周期间（HMO和NAMCS样本）使用一种以上抗精神病药物。通过多变量逻辑回归评估联合用药与住院的关联。
VA样本中的抗精神病药物使用率在74%至78%之间，NAMCS样本（69 - 84%）和HMO样本（22 - 67%）中的使用率较低且变化较大。发现VA患者的联合用药率（20 - 22%）低于HMO和NAMCS样本中的患者（19 - 31%）。在所有评估样本中，联合用药与住院可能性增加相关（比值比范围为1.4 - 2.4）。
一项多系统研究表明，精神分裂症患者的抗精神病药物使用在不同医疗系统之间存在很大差异，并且在大多数医疗系统中，近五分之一的精神分裂症或其他精神障碍患者经历过抗精神病药物联合用药。
