Efron Daryl, Danchin Margie H, Cranswick Noel E, Gulenc Alisha, Hearps Stephen, Hiscock Harriet
Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2017 Oct;53(10):957-962. doi: 10.1111/jpc.13615. Epub 2017 Jun 30.
The aims of this study were to examine: (i) medications prescribed by Australian general and community paediatricians, (ii) predictors of prescribing (child age, gender) and (iii) changes in medication prescription between 2008 and 2013.
Two patient-level practice national audits were conducted by the Australian Paediatric Research Network in 2008 and 2013. General and community paediatricians in outpatient clinics and private practices recorded demographic data, diagnoses and medications prescribed for all patients seen over a 2-week period.
In 2008, 199 paediatricians submitted data on 8345 consultations, and in 2013, 180 paediatricians submitted data on 7102 consultations. The most frequently prescribed drug class was psychotropics, prescribed for 46.8% of patients with developmental-behavioural/mental health (DB/MH) diagnoses in 2008 and 49.8% in 2013 (P = 0.015). Within this class, in 2013, the stimulants were prescribed in 35.3% of DB/MH consultations, antidepressants in 7.8% and antipsychotics in 5.6%. The next most frequently prescribed drug classes were laxatives (4.6% of all consultations in 2013), asthma preventers (4.1%), melatonin (3.7%), asthma relievers (2.6%) and proton-pump inhibitors (2.2%), topical corticosteroids (1.8%) and antihistamines (1.4%). Medication prescription was predicted by patient age (P < 0.001, both audits) and male gender (P < 0.01, both audits) but not by measured prescriber variables. The rates of prescribing of psychotropics, melatonin, laxatives and enuresis medications increased between 2008 and 2013.
Australian paediatricians prescribe mostly psychotropic medications, and the amount prescribed appears to be increasing. Paediatricians need good training and professional development in mental health diagnosis and management and the rational prescribing of psychotropic medications.
本研究的目的是考察：（i）澳大利亚普通及社区儿科医生所开的药物，（ii）开药的预测因素（儿童年龄、性别）以及（iii）2008年至2013年间药物处方的变化。
澳大利亚儿科研究网络在2008年和2013年进行了两次针对患者层面的全国性实践审计。门诊诊所和私人诊所的普通及社区儿科医生记录了为期两周内所有就诊患者的人口统计学数据、诊断结果及所开药物。
2008年，199名儿科医生提交了8345次会诊的数据，2013年，180名儿科医生提交了7102次会诊的数据。最常开具的药物类别是精神药物，2008年在发育行为/心理健康（DB/MH）诊断患者中开具率为46.8%，2013年为49.8%（P = 0.015）。在这一类别中，2013年，兴奋剂在35.3%的DB/MH会诊中被开具，抗抑郁药为7.8%，抗精神病药为5.6%。接下来最常开具的药物类别是泻药（2013年占所有会诊的4.6%）、哮喘预防药（4.1%）、褪黑素（3.7%）、哮喘缓解药（2.6%）和质子泵抑制剂（2.2%）、外用皮质类固醇（1.8%）和抗组胺药（1.4%）。药物处方可由患者年龄预测（两次审计P均<0.001）和男性性别预测（两次审计P均<0.01），但不受所测量的开处方者变量影响。2008年至2013年间，精神药物、褪黑素、泻药和遗尿症药物的开具率有所增加。
澳大利亚儿科医生大多开具精神药物，且开具量似乎在增加。儿科医生需要在心理健康诊断和管理以及精神药物合理处方方面接受良好的培训和专业发展。
