抗精神病药物的药房换药：患者视角
Pharmacy switch of antipsychotic medications: patient's perspective.
作者信息
Murawiec Slawomir, Rajewska-Rager Aleksandra, Samochowiec Jerzy, Kalinowska Sylwia, Kurpisz Jacek, Krzyzanowska Joanna, Sienkiewicz-Jarosz Halina, Kurkowska-Jastrzebska Iwona, Samochowiec Agnieszka, Bienkowski Przemyslaw
机构信息
Institute of Psychiatry and Neurology, 9 Sobieskiego St., 02957 Warsaw, Poland.
Department of Psychiatry, Medical University, Poznan, Poland.
出版信息
Ann Gen Psychiatry. 2015 Sep 25;14:31. doi: 10.1186/s12991-015-0066-y. eCollection 2015.
BACKGROUND AND AIM
Several studies have raised concerns over consequences of brand-to-generic and generic-to-generic pharmacy-generated medication substitutions in psychiatric and non-psychiatric patients. The purpose of this retrospective study was to assess behavioral and emotional responses of patients with schizophrenia to antipsychotic medication substitution performed by pharmacies.
METHODS
A group of Polish ambulatory patients with schizophrenia (n = 196) chronically treated with antipsychotic medications were asked whether antipsychotic medication substitution had been proposed by a pharmacist in the last 12 months. Ninety-nine patients answering positively were administered more questions addressing the patient's emotional and behavioral response to the pharmacy proposal.
RESULTS
The most important findings of the present study can be summarized as follows: (1) approximately half of the patients were confronted with a pharmacy proposal to switch their antipsychotic medications in the last 12 months, (2) one quarter of these patients did not accept the pharmacy switch, (3) a substantial proportion of patients (>40 %) did not receive any explanation from a pharmacist offering medication substitution, (4) pharmacy-generated substitution proposals were mainly associated with negative patient attitudes and negative emotional responses, (5) substitution proposals provoked an unscheduled psychiatric visit in approx. 10 % of patients, (6) despite the negative attitudes reported by patients, the pharmacy switch rarely led to treatment discontinuation, but did provoke a change in drug dosing in 7 % of patients accepting the switch.
CONCLUSIONS
A pharmacy proposal to switch their antipsychotic medications is a relatively common experience of Polish ambulatory patients with schizophrenia. Pharmacy-generated substitution proposals are mainly associated with negative patient attitudes, but rarely lead to antipsychotic treatment discontinuation in this group of patients.
背景与目的
多项研究引发了人们对精神科和非精神科患者中，由品牌药换为仿制药以及仿制药之间的药房产生的药物替换后果的担忧。这项回顾性研究的目的是评估精神分裂症患者对抗精神病药物替换的行为和情绪反应，该替换由药房进行。
方法
一组长期接受抗精神病药物治疗的波兰门诊精神分裂症患者（n = 196）被问及在过去12个月内药剂师是否曾提出过抗精神病药物替换建议。99名给出肯定回答的患者被进一步询问了更多关于患者对药房建议的情绪和行为反应的问题。
结果
本研究的最重要发现可总结如下：（1）在过去12个月中，约一半的患者面临药房提出的更换抗精神病药物的建议；（2）这些患者中有四分之一不接受药房的更换建议；（3）相当一部分患者（>40%）没有从提供药物替换建议的药剂师那里得到任何解释；（4）药房产生的替换建议主要与患者的消极态度和负面情绪反应相关；（5）替换建议在约10%的患者中引发了非计划内的精神科就诊；（6）尽管患者报告了消极态度，但药房更换很少导致治疗中断，但在接受更换的患者中有7%确实引发了药物剂量的改变。
结论
药房提出更换抗精神病药物的建议是波兰门诊精神分裂症患者相对常见的经历。药房产生的替换建议主要与患者的消极态度相关，但在这组患者中很少导致抗精神病治疗中断。
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