Professor and holds the Alberta Health Services Chair in Primary Care Research in the Department of Family Medicine at the University of Alberta in Calgary.
Associate Professor in the Department of Nursing at Brock University in St Catharines, Ont.
Can Fam Physician. 2018 Nov;64(11):e488-e497.
To use data from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN) to evaluate the prevalence of antidepressant and antipsychotic prescriptions among patients with no previous depression or psychosis diagnoses, and to identify the factors associated with the use of these drugs in this population.
Retrospective cohort study using data derived from CPCSSN.
Primary care practices associated with CPCSSN.
Patients who were born before 1949; who were associated with a CPCSSN primary care practitioner between October 1, 2007, and September 30, 2013; and whose electronic medical records contained data from at least 6 months before and 12 months after the date of dementia diagnosis.
Prescription for an antidepressant or antipsychotic medication in the absence of a depression or psychosis diagnosis. Multivariable models were fitted to determine estimated odds ratios (ORs) and were adjusted for age and sex.
Of the 3252 patients without a depression diagnosis, 8.5% received a new prescription for an antidepressant in the 12 months following their diagnosis of dementia. Prescribing was reduced in association with older age (OR of 0.86 per 5-year age increase, =.001) and male sex (OR=0.77, =.056), and prescribing increased in association with prescription of cholinesterase inhibitor medications (OR=1.57, =.003). Of the 4262 patients without a diagnosis of psychosis, 6.1% received a new prescription for an antipsychotic in the 12 months following their diagnosis of dementia. Higher rates of antipsychotic prescriptions were reported in men (OR=1.31, =.046), those receiving a prescription for steroids (OR=1.90, =.037), and those diagnosed with Parkinson disease (OR 1.58, =.051).
A substantial number of patients with dementia are being prescribed antidepressant or antipsychotic medications by their primary care practitioners without evidence of depression or psychosis in their electronic medical records.
利用加拿大初级保健监测网络（CPCSSN）的数据评估既往无抑郁或精神病诊断患者中抗抑郁药和抗精神病药的处方率，并确定该人群中使用这些药物的相关因素。
利用 CPCSSN 数据进行的回顾性队列研究。
与 CPCSSN 相关的初级保健实践。
患者于 1949 年以前出生；于 2007 年 10 月 1 日至 2013 年 9 月 30 日期间与 CPCSSN 初级保健医生相关联；且其电子病历中包含至少在痴呆症诊断日期前 6 个月和诊断日期后 12 个月的数据。
在无抑郁或精神病诊断的情况下开处抗抑郁或抗精神病药物。采用多变量模型确定估计比值比（OR），并按年龄和性别进行调整。
在 3252 例无抑郁诊断的患者中，有 8.5%在诊断为痴呆后 12 个月内接受了新的抗抑郁药处方。随着年龄的增加（每增加 5 岁，OR 为 0.86，.001）和男性（OR=0.77，.056），处方减少，与处方胆碱酯酶抑制剂药物（OR=1.57，.003）增加相关。在 4262 例无精神病诊断的患者中，有 6.1%在诊断为痴呆后 12 个月内接受了新的抗精神病药处方。男性（OR=1.31，.046）、接受类固醇处方（OR=1.90，.037）和诊断为帕金森病（OR 1.58，.051）的患者报告的抗精神病药处方率更高。
相当数量的痴呆症患者的初级保健医生在其电子病历中未发现抑郁或精神病的情况下开具了抗抑郁药或抗精神病药物。
