Berrouiguet Sofian, Barrigón Maria Luisa, Brandt Sara A, Nitzburg George C, Ovejero Santiago, Alvarez-Garcia Raquel, Carballo Juan, Walter Michel, Billot Romain, Lenca Philippe, Delgado-Gomez David, Ropars Juliette, de la Calle Gonzalez Ivan, Courtet Philippe, Baca-García Enrique
Department of Psychiatry, Brest Medical University Hospital at Brest, Brest, France.
UMR CNRS 6285 Lab-STICC, Institut Mines-Telecom, Brest, France.
J Med Internet Res. 2017 Jan 26;19(1):e25. doi: 10.2196/jmir.5954.
Electronic prescribing devices with clinical decision support systems (CDSSs) hold the potential to significantly improve pharmacological treatment management.
The aim of our study was to develop a novel Web- and mobile phone-based application to provide a dynamic CDSS by monitoring and analyzing practitioners' antipsychotic prescription habits and simultaneously linking these data to inpatients' symptom changes.
We recruited 353 psychiatric inpatients whose symptom levels and prescribed medications were inputted into the MEmind application. We standardized all medications in the MEmind database using the Anatomical Therapeutic Chemical (ATC) classification system and the defined daily dose (DDD). For each patient, MEmind calculated an average for the daily dose prescribed for antipsychotics (using the N05A ATC code), prescribed daily dose (PDD), and the PDD to DDD ratio.
MEmind results found that antipsychotics were used by 61.5% (217/353) of inpatients, with the largest proportion being patients with schizophrenia spectrum disorders (33.4%, 118/353). Of the 217 patients, 137 (63.2%, 137/217) were administered pharmacological monotherapy and 80 (36.8%, 80/217) were administered polytherapy. Antipsychotics were used mostly in schizophrenia spectrum and related psychotic disorders, but they were also prescribed in other nonpsychotic diagnoses. Notably, we observed polypharmacy going against current antipsychotics guidelines.
MEmind data indicated that antipsychotic polypharmacy and off-label use in inpatient units is commonly practiced. MEmind holds the potential to create a dynamic CDSS that provides real-time tracking of prescription practices and symptom change. Such feedback can help practitioners determine a maximally therapeutic drug treatment while avoiding unproductive overprescription and off-label use.
配备临床决策支持系统（CDSS）的电子处方设备有显著改善药物治疗管理的潜力。
我们研究的目的是开发一种新颖的基于网络和手机的应用程序，通过监测和分析从业者的抗精神病药物处方习惯，并同时将这些数据与住院患者的症状变化相联系，来提供动态CDSS。
我们招募了353名精神科住院患者，将他们的症状水平和所开药物输入到MEmind应用程序中。我们使用解剖治疗学化学（ATC）分类系统和限定日剂量（DDD）对MEmind数据库中的所有药物进行标准化。对于每位患者，MEmind计算抗精神病药物（使用N05A ATC代码）的规定日剂量、规定每日剂量（PDD）以及PDD与DDD的比值的平均值。
MEmind结果发现，61.5%（217/353）的住院患者使用了抗精神病药物，其中比例最大的是精神分裂症谱系障碍患者（33.4%，118/353）。在这217名患者中，137名（63.2%，137/217）接受了药物单一疗法，80名（36.8%，80/217）接受了联合疗法。抗精神病药物主要用于精神分裂症谱系及相关精神障碍，但也用于其他非精神病性诊断。值得注意的是，我们观察到联合用药违背了当前的抗精神病药物指南。
MEmind数据表明，住院病房中抗精神病药物联合用药和超说明书用药很常见。MEmind有潜力创建一个动态CDSS，实时跟踪处方行为和症状变化。这种反馈可以帮助从业者确定最大程度的治疗性药物治疗，同时避免无效的过度处方和超说明书用药。
