Department of Public Health and Epidemiology, Meiji Pharmaceutical University, 2-522-1, Noshio, Kiyose, Tokyo, 204-8588, Japan.
Soc Psychiatry Psychiatr Epidemiol. 2022 Feb;57(2):411-422. doi: 10.1007/s00127-021-02147-0. Epub 2021 Jul 31.
According to the revised Japanese medical service fees aimed at reducing irrational psychotropic polypharmacy, medical service fees are reduced if the number of simultaneously prescribed psychotropic drugs exceeds the standard. This study primarily aims to examine the effect of the 2018 revision.
Using a large Japanese administrative claims database, we retrospectively identified five groups (April 2013-September 2018) prescribed at least one drug from the following drug groups: anxiolytics, hypnotics, sum of anxiolytics and hypnotics, antipsychotics, and antidepressants (study population in each group: 547,511, 406,524, 759,137, 112,929, and 201,046, respectively). We used an interrupted time-series design to evaluate changes in the proportion of patients prescribed more than the standard number of drugs.
After the 2018 revision, the proportion of patients prescribed more than the standard number of drugs significantly decreased only for the sum of anxiolytics and hypnotics; estimated changes in level and trend were - 0.60% [- 0.69%, - 0.52%] and - 0.04% [- 0.06%, - 0.02%] per month, respectively. The proportion of patients exhibiting a decrease in the number of prescribed drugs from more than the standard to within the standard increased when the revision was enforced (April 2018); this proportion in April 2018 was 36.3%, while all other proportions were in the range of 12.1-22.3%.
The 2018 revision promoted a reduction in the number of prescribed drugs, which served as an important factor in the decrease in the proportion of patients prescribed more than the standard number of drugs for the sum of anxiolytics and hypnotics.
根据修订后的日本医疗服务费用标准，旨在减少不合理的精神类药物多药联用，如果同时开具的精神类药物数量超过标准，医疗服务费用将会降低。本研究主要旨在检验 2018 年修订版的效果。
我们使用大型日本行政索赔数据库，回顾性地确定了五个组（2013 年 4 月至 2018 年 9 月），每个组至少开具了以下药物组中的一种药物：抗焦虑药、催眠药、抗焦虑药和催眠药的总和、抗精神病药和抗抑郁药（每组的研究人群分别为：547511、406524、759137、112929 和 201046）。我们使用中断时间序列设计来评估超过标准数量的药物处方患者比例的变化。
2018 年修订后，仅抗焦虑药和催眠药的总和的患者开具超过标准数量药物的比例显著降低；估计水平和趋势的变化分别为-0.60%[-0.69%，-0.52%]和-0.04%[-0.06%，-0.02%]，每月一次。修订版生效时，开具的药物数量从超过标准减少到标准内的患者比例增加（2018 年 4 月）；该比例在 2018 年 4 月为 36.3%，而其他所有比例均在 12.1%-22.3%之间。
2018 年修订版促进了开具药物数量的减少，这是抗焦虑药和催眠药的总和中开具超过标准数量药物的患者比例下降的重要因素。
