Huang Hsiang, Gören Jessica L, Chan Ya-Fen, Katon Wayne, Russo Joan, Hogan Diane, Unützer Jürgen
Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA (H.H.).
Pharmacy Practice/Clinical Pharmacy/Psychiatry, University of RI/CHA/Harvard, Somerville, MA (J.L.G.).
Psychosomatics. 2014 Nov-Dec;55(6):572-7. doi: 10.1016/j.psym.2014.02.005. Epub 2014 Apr 19.
The purpose of this study was to examine patterns of pharmacotherapy for beneficiaries in a high-risk Medicare Advantage program who were diagnosed with bipolar disorder.
This was a cross-sectional study of 2338 Medicare Advantage beneficiaries diagnosed with bipolar disorder. Pharmacotherapy treatment was assessed via receipt of (1) a mood stabilizer or antipsychotic or both (i.e., guideline concordant bipolar care) and (2) unopposed antidepressant (i.e., without prescription of a mood stabilizer or an antipsychotic). Logistic regression was used to examine correlates of bipolar disorder care.
Among those younger than 65 years of age (n = 1395), 54% received guideline concordant therapy and 29% received unopposed antidepressant therapy. Among those 65 years and older (n = 943), 40% received guideline concordant therapy and 33% received unopposed antidepressant therapy.
Overall, about half of beneficiaries in this Medicare Advantage plan received guideline concordant pharmacotherapy for bipolar disorder, while approximately one-third received an unopposed antidepressant prescription. Antipsychotic medications accounted for most of the monotherapy observed. This study identifies opportunities for further improvements in the pharmacotherapy of bipolar disorder in high-risk Medicare patients.
本研究旨在调查被诊断为双相情感障碍的高风险医疗保险优势计划受益人的药物治疗模式。
这是一项对2338名被诊断为双相情感障碍的医疗保险优势计划受益人的横断面研究。通过是否接受以下治疗来评估药物治疗情况：（1）一种心境稳定剂或抗精神病药物或两者皆用（即符合指南的双相情感障碍治疗），以及（2）单纯使用抗抑郁药（即未开具心境稳定剂或抗精神病药物的处方）。采用逻辑回归分析双相情感障碍治疗的相关因素。
在65岁以下的人群（n = 1395）中，54%接受了符合指南的治疗，29%接受了单纯抗抑郁药治疗。在65岁及以上的人群（n = 943）中，40%接受了符合指南的治疗，33%接受了单纯抗抑郁药治疗。
总体而言，该医疗保险优势计划中约一半的受益人接受了符合指南的双相情感障碍药物治疗，而约三分之一的受益人接受了单纯抗抑郁药处方。抗精神病药物占观察到的单一疗法的大部分。本研究确定了在高风险医疗保险患者中进一步改善双相情感障碍药物治疗的机会。
