Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Department of Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
Int J Geriatr Psychiatry. 2021 Mar;36(3):443-451. doi: 10.1002/gps.5442. Epub 2020 Oct 16.
Psychotropic drugs are frequently prescribed to people with dementia in nursing homes although severe adverse events and side effects are common. Less is known about the prevalence and types of psychotropic drug prescription in primary care for people with dementia.
This study examined the prevalence of psychotropic drug prescriptions in primary care among persons with dementia from the year of diagnosis onwards.
A longitudinal observational study using electronic health record (EHR) data was conducted. People with dementia were selected from EHR data of 451 general practices in the Netherlands. Age and gender-adjusted psychotropic drug prescription rates were calculated per 1000 person-years from the year the dementia diagnosis was first recorded in general practice up to 8 years after diagnosis.
Data of 15,687 patients were analyzed. The prescription rate of psychotropic drugs (not including antidementia drugs) was 420 per 1000 person-years (95% CI 409; 431) in the first year after the recorded dementia diagnosis, which increased to 801 per 1000 person-years (95% CI 649; 989) in the eighth year. The most frequently prescribed drugs were antidepressants, antipsychotics, and antidementia drugs, followed by anxiolytics, hypnotics, and antiepileptics.
After a dementia diagnosis is recorded in general practice, the prevalence of psychotropic drug prescriptions is substantial and increases steadily during the disease trajectory of persons with dementia. Although the (in)appropriateness of prescribing was not assessed, these insights may stimulate primary care clinicians to (re)consider their prescription policy of psychotropics for people with dementia more carefully.
尽管精神药物经常被开给疗养院中的痴呆患者，但严重的不良反应和副作用很常见。在初级保健中，针对痴呆患者开具精神药物的情况和类型知之甚少。
本研究旨在调查从诊断开始后，初级保健中痴呆患者精神药物的开具情况。
采用电子健康记录（EHR）数据的纵向观察性研究。从荷兰 451 家全科诊所的 EHR 数据中选择痴呆患者。从首次在全科诊所记录痴呆诊断之日起，计算每 1000 人年的年龄和性别调整后精神药物处方率，直至诊断后 8 年。
共分析了 15687 名患者的数据。在记录痴呆诊断后的第一年，精神药物（不包括抗痴呆药物）的处方率为 420 人/1000 人年（95%CI 409；431），在第八年增加至 801 人/1000 人年（95%CI 649；989）。最常开具的药物是抗抑郁药、抗精神病药和抗痴呆药，其次是抗焦虑药、催眠药和抗癫痫药。
在全科诊所记录痴呆诊断后，精神药物的开具率相当高，并在痴呆患者的疾病轨迹中稳步上升。尽管未评估开具的（适当性），但这些结果可能会促使初级保健临床医生更仔细地考虑其针对痴呆患者开具精神药物的处方政策。
