全科医生的诊疗方式和患者特征如何影响抗抑郁药的处方？一项横断面研究。
How do GP practices and patient characteristics influence the prescription of antidepressants? A cross-sectional study.
作者信息
Mercier Alain, Benichou Jacques, Auger-Aubin Isabelle, Lebeau Jean-Pierre, Houivet Estelle, Van Royen Paul, Peremans Lieve
机构信息
Department of General Practice, Rouen University, CIC Inserm 0204, 1 rue de Germont, 76031 Rouen Cedex, France ; Department of General Practice, University Paris 13, Sorbonne Paris Cité, Bobigny, France ; Department of Family practice, Faculty of Medicine, Rouen University, 20 Bd Gambetta, 76000 Rouen, France.
Department of Biostatistics, Inserm U 657, University of Rouen, Rouen University Hospital, 1 rue de Germont, 76031 Rouen Cedex, France.
出版信息
Ann Gen Psychiatry. 2015 Jan 22;14(1):3. doi: 10.1186/s12991-015-0041-7. eCollection 2015.
BACKGROUND
Under-prescription of antidepressants (ADs) among people meeting the criteria for major depressive episodes and excessive prescription in less symptomatic patients have been reported. The reasons influencing general practitioners' (GPs) prescription of ADs remain little explored. This study aimed at assessing the influence of GP and patient characteristics on AD prescription.
METHODS
This cross-sectional study was based on a sample of 816 GPs working within the main health care insurance system in the Seine-Maritime district of France during 2010. Only GPs meeting the criteria for full-time GP practice were included. The ratio of AD prescription to overall prescription volume, a relative measure of AD prescription level, was calculated for each GP, using the defined daily dose (DDD) concept. Associations of this AD prescription ratio with GPs' age, gender, practice location, number of years of practice, number of days of sickness certificates prescribed, number of home visits and consultations, number and mean age of registered patients, mean patient income, and number of patients with a chronic condition were assessed using univariate and multivariate analysis.
RESULTS
The high prescribers were middle-aged (40-59) urban GPs, with a moderate number of consultations and fewer low-income and chronic patients. GPs' workload (e.g., volume of prescribed drug reimbursement and number of consultations) had no influence on the AD prescription ratio. GPs with more patients with risk factors for depression prescribed fewer ADs, however, which could suggest the medications were under-prescribed among the at-risk population.
CONCLUSIONS
Our study described a profile of the typical higher AD prescriber that did not include heavy workload. In future work, a more detailed assessment of all biopsychosocial components of the consultation and other influences on GP behavior such as prior training would be useful to explain AD prescription in GP's practice.
背景
据报道，在符合重度抑郁发作标准的人群中，抗抑郁药（ADs）存在处方不足的情况，而在症状较轻的患者中则存在过度处方的现象。影响全科医生（GPs）开具抗抑郁药处方的原因仍鲜为人知。本研究旨在评估全科医生和患者特征对抗抑郁药处方的影响。
方法
这项横断面研究基于2010年在法国滨海塞纳省主要医疗保险系统内工作的816名全科医生样本。仅纳入符合全职全科医生执业标准的全科医生。使用限定日剂量（DDD）概念，为每位全科医生计算抗抑郁药处方量与总处方量的比率，这是抗抑郁药处方水平的相对衡量指标。使用单变量和多变量分析评估该抗抑郁药处方比率与全科医生的年龄、性别、执业地点、执业年限、开具病假证明的天数、家访和会诊次数、注册患者数量和平均年龄、患者平均收入以及慢性病患者数量之间的关联。
结果
开具抗抑郁药较多的是中年（40 - 59岁）城市全科医生，会诊次数适中，低收入和慢性病患者较少。全科医生的工作量（如处方药报销量和会诊次数）对抗抑郁药处方比率没有影响。然而，抑郁症危险因素患者较多的全科医生开具的抗抑郁药较少，这可能表明在高危人群中药物处方不足。
结论
我们的研究描述了典型的开具抗抑郁药较多的全科医生的特征，其中不包括工作量大。在未来的工作中，更详细地评估会诊的所有生物心理社会组成部分以及其他对全科医生行为的影响，如先前的培训，将有助于解释全科医生实践中的抗抑郁药处方情况。
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