San Francisco Veterans Affairs Health Care System, San Francisco, California.
Sierra Pacific Mental Illness Research, Education, and Clinical Center, San Francisco, California.
J Clin Psychiatry. 2021 May 4;82(3):20m13522. doi: 10.4088/JCP.20m13522.
To evaluate longitudinal prescription practice trends for patients diagnosed with posttraumatic stress disorder (PTSD) using a national cohort of veterans who engaged in Veterans Health Administration (VHA) care from 2009 to 2018.
Using ICD-9 and ICD-10 codes to determine diagnoses, 1,353,416 patients diagnosed with PTSD in VHA care were retrospectively identified who were not diagnosed with bipolar or psychotic spectrum disorder. Veterans were included in the analytic sample starting in the year of their first PTSD diagnosis for each year that they were active in VHA care. Outpatient prescription records were examined from 2009 to 2018 for medications that are commonly used as recommended (selective serotonin reuptake inhibitors [SSRIs], serotonin-norepinephrine reuptake inhibitors [SNRIs]) or second-line/adjunctive (atypical antipsychotics [AAPs], mirtazapine, prazosin, trazodone, tricyclic antidepressants, and non-benzodiazepine hypnotics) medications for PTSD. Benzodiazepine prescriptions were also examined.
From 2009 to 2018, the percentage of patients active in VHA care who received at least one of the examined recommended or second-line/adjunctive medications for PTSD in a calendar year declined by 9.0% (absolute change). The largest absolute change in rates of prescribing for medication classes over the last decade were observed among SSRIs (-12.3%) and SNRIs (+6.4%). AAP use decreased 5.4% from 2009 to 2018, with most of this change (-4.3%) occurring from 2009 to 2013.
Consistent with clinical practice guidelines, SSRIs/SNRIs were the most common prescriptions for patients in the current study. Reductions in the percentage of patients receiving PTSD medications may reflect concerns regarding effectiveness, adverse side effects, increases in access to evidence-based psychotherapy for PTSD, and/or symptom improvement such that medication was no longer needed.
使用参与退伍军人事务部 (VHA) 护理的全国退伍军人队列评估 2009 年至 2018 年期间创伤后应激障碍 (PTSD) 患者的纵向处方实践趋势。
使用 ICD-9 和 ICD-10 代码确定诊断，在 VHA 护理中诊断为 PTSD 的 1,353,416 名患者中，未诊断为双相或精神病谱系障碍。退伍军人从 PTSD 首次诊断的那一年开始纳入分析样本，每年都在 VHA 护理中活跃。从 2009 年至 2018 年，检查门诊处方记录中常用于推荐的药物（选择性 5-羟色胺再摄取抑制剂 [SSRIs]、5-羟色胺去甲肾上腺素再摄取抑制剂 [SNRIs]）或二线/辅助药物（非典型抗精神病药 [AAPs]、米氮平、普萘洛尔、曲唑酮、三环抗抑郁药和非苯二氮䓬类催眠药）治疗 PTSD。还检查了苯二氮䓬类药物的处方。
从 2009 年到 2018 年，在日历年中至少接受一种检查过的 PTSD 推荐或二线/辅助药物治疗的活跃退伍军人事务部护理患者的百分比下降了 9.0%（绝对变化）。过去十年中，药物类别处方率的最大绝对变化发生在 SSRIs（-12.3%）和 SNRIs（+6.4%）中。AAP 的使用从 2009 年到 2018 年下降了 5.4%，其中大部分变化（-4.3%）发生在 2009 年至 2013 年。
与临床实践指南一致，SSRIs/SNRIs 是当前研究中患者最常见的处方。接受 PTSD 药物治疗的患者百分比下降可能反映了对有效性、不良反应、获得 PTSD 循证心理治疗的增加以及/或症状改善的关注，以至于不再需要药物治疗。
