Carrier Jean-Daniel, Blais Lucie, Cohen Alan, Courteau Josiane, Roberge Pasquale, Larouche Annie, Grignon Sylvain, Fleury Marie-Josée, Lesage Alain, Demers Marie-France, Roy Marc-André, Delorme André, Vanasse Alain
Groupe de recherche PRIMUS, Centre de recherche du Centre hospitalier de l'Université de Sherbrooke (CHUS), Québec, Canada ; Département de psychiatrie, Université de Sherbrooke, Québec, Canada.
Faculté de pharmacie, Université de Montréal, Québec, Canada ; Centre de recherche, Hôpital du Sacré-Coeur de Montréal, Québec, Canada ; Chaire pharmaceutique AstraZeneca en santé respiratoire, Montréal, Québec, Canada.
Sante Ment Que. 2017 Spring;42(1):85-103.
Objectives To describe factors associated with the following characteristics of the first prescription of an antipsychotic drug treatment (ADT): 1) prescribing physician type (psychiatrist vs. general practitioner); 2) second-generation vs. first-generation antipsychotic drug; 3) in conjunction with at least one additional antipsychotic drug (multitherapy); 4) never renewed by the patient.Methods This is a pharmacoepidemiologic study using administrative data from the Régie de l'assurance maladie du Québec (RAMQ), the public healthcare insurer in Quebec, Canada. Available data sample was exhaustive for adults with a diagnosis of schizophrenia who received an ADT under RAMQ drug coverage from 1998 to 2006. We report multiple logistic regression results.Results Among 16,225 patients who met inclusion criteria 46.2% were women and 70% were beneficiaries of governmental financial assistance. Patients who had their ADT prescribed by psychiatrists tended to be younger and were more burdened by their mental illness. Multitherapy was associated with hospitalization with a psychotic disorder as main diagnosis, lower socioeconomic status, and age between 35 and 64. Second-generation antipsychotic use became progressively more prominent during the period under study. Antipsychotic non renewal was correlated with substance use disorders and was less likely to happen following hospitalization with a psychiatric main diagnosis. Conclusions Although this study is subject to the intrinsic limitations of secondary analysis of administrative data, the database available for study was exhaustive within the Quebec healthcare system and included data from both general practice and specialized care, which allowed us to draw a relevant picture of how ADT were initiated for schizophrenia in Quebec, Canada, from 1998 to 2006. This timeframe is especially relevant since the 1990s were marked by the introduction of second-generation antipsychotics in Canada.
目的 描述与抗精神病药物治疗（ADT）首次处方的以下特征相关的因素：1）开处方医生类型（精神科医生与全科医生）；2）第二代与第一代抗精神病药物；3）与至少一种其他抗精神病药物联合使用（多药治疗）；4）患者从未续签。方法 这是一项药物流行病学研究，使用了加拿大魁北克公共医疗保险机构魁北克医疗保险局（RAMQ）的行政数据。对于1998年至2006年在RAMQ药物覆盖范围内接受ADT治疗的精神分裂症成年患者，可用数据样本是详尽无遗的。我们报告了多重逻辑回归结果。结果 在符合纳入标准的16225名患者中，46.2%为女性，70%为政府财政援助受益人。由精神科医生开具ADT处方的患者往往更年轻，且精神疾病负担更重。多药治疗与以精神障碍为主要诊断的住院治疗、较低的社会经济地位以及35至64岁的年龄相关。在研究期间，第二代抗精神病药物的使用逐渐变得更加突出。抗精神病药物未续签与物质使用障碍相关，并且在以精神科主要诊断住院后发生的可能性较小。结论 尽管本研究受到行政数据二次分析的固有局限性的影响，但可用于研究的数据库在魁北克医疗系统内是详尽无遗的，并且包括了全科医疗和专科护理的数据，这使我们能够描绘出1998年至2006年加拿大魁北克精神分裂症患者ADT治疗的起始情况。自20世纪90年代加拿大引入第二代抗精神病药物以来，这个时间框架尤其具有相关性。
