瑞典初级保健中精神药物处方的态度和行为：问卷调查研究。
Attitudes and behaviour towards psychotropic drug prescribing in Swedish primary care: a questionnaire study.
机构信息
Närhälsan Hjällbo GP Practice, Bergsgårdsgärdet 89B, SE-424 32, Angered, Sweden.
Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
出版信息
BMC Fam Pract. 2019 Jan 5;20(1):4. doi: 10.1186/s12875-018-0885-4.
BACKGROUND
The prescribing of psychotropic drugs, i.e. antidepressants, sedatives (anxiolytics, hypnotics), and antipsychotics is considerable and a large proportion is prescribed by general practitioners (GPs). There are concerns about dependency and medicalisation, and treatment decisions in psychiatry may appear arbitrary. Increased knowledge of GPs' opinions on the prescribing of psychotropics may lead to more rational use of these drugs. We aimed to quantify GPs' attitudes, beliefs and behaviour towards various aspects of psychotropic drug prescribing.
METHODS
A questionnaire was distributed to physicians in all 199 GP practices in Region Västra Götaland, Sweden. The questions concerned determinants of psychotropic drug prescribing that had been identified in a previous, qualitative study.
RESULTS
Questionnaires from 516 physicians (64% of whom were specialists in family medicine, 21% interns in family medicine, 15% others) at 152 GP practices (59% of which were state owned, 72% in an urban area, with a median of 7808 registered patients) were returned (estimated response rate: 48%). A majority - 62% - of GPs found it easier to start prescribing psychotropic drugs than to stop (95% confidence interval, 57%, 66%) vs. 8% (6%, 10%). Most GPs considered psychotherapy more suitable than psychotropic drugs in cases of mild psychiatric disease: 81% (77%, 84%) vs. 4% (3%, 6%). The problems treated with psychotropic drugs were considered to be mostly socioeconomic, or mostly medical, by similar proportions of physicians: 38% (34%, 42%) vs. 40% (36%, 45%). GPs were on average satisfied with their levels of antidepressant and sedative prescribing in relation to medical needs. More GPs regarded their prescribing of antipsychotics as being too low rather than too high: 33% (28%, 39%) vs. 7% (4%, 10%).
CONCLUSIONS
This study illustrates the complexities of psychiatric drug treatment in primary care and identifies potential drivers of increased prescribing of psychotropics. The manifold factors, medical and non-medical, that affect prescribing decisions may explain a sense of arbitrariness surrounding psychotropic drug treatment. This notwithstanding, GPs seem mostly content with their prescribing.
背景
精神药物的处方，即抗抑郁药、镇静剂（抗焦虑药、催眠药）和抗精神病药，数量相当大，其中很大一部分是由全科医生（GP）开出的。人们对药物依赖和医学化的治疗存在担忧，精神科的治疗决策可能显得随意。增加对全科医生对精神药物处方的意见的了解，可能会导致这些药物的更合理使用。我们的目的是量化全科医生对精神药物处方各个方面的态度、信念和行为。
方法
向瑞典西约塔兰地区的所有 199 家全科医生诊所的医生分发了一份问卷。这些问题涉及到之前一项定性研究中确定的精神药物处方的决定因素。
结果
从 152 家全科医生诊所（其中 59%为国有，72%位于城市地区，平均有 7808 名注册患者）的 516 名医生（其中 64%为家庭医学专家，21%为家庭医学实习生，15%为其他医生）中收回了问卷（估计回复率：48%）。大多数全科医生认为，开始开精神药物处方比停止开处方更容易：62%（95%置信区间，57%，66%），而 8%（6%，10%）的医生认为停止开处方更容易。大多数全科医生认为，在轻度精神疾病的情况下，心理治疗比精神药物更合适：81%（77%，84%），而 4%（3%，6%）的医生认为精神药物更合适。接受精神药物治疗的问题被认为主要是社会经济问题，或者主要是医学问题，这两种情况被医生认为是同样比例的：38%（34%，42%），而 40%（36%，45%）的医生认为是医学问题。全科医生对他们根据医疗需求开出的抗抑郁药和镇静剂处方的水平平均感到满意。更多的全科医生认为他们的抗精神病药物处方开得太低而不是太高：33%（28%，39%），而 7%（4%，10%）的医生认为他们的抗精神病药物处方开得太高。
结论
这项研究说明了初级保健中心精神药物治疗的复杂性，并确定了增加精神药物处方的潜在驱动因素。影响处方决策的医学和非医学的多方面因素，可能解释了精神药物治疗周围存在的随意性。尽管如此，全科医生似乎对他们的处方感到满意。
Zotero 插件