呼吁制定合理的多药联合治疗政策：来自精神科医生的国际见解。
A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists.
作者信息
Nakagami Yukako, Hayakawa Kohei, Horinouchi Toru, Pereira-Sanchez Victor, Tan Marcus P J, Park Seon-Cheol, Park Yong Chon, Moon Seok Woo, Choi Tae Young, Avasthi Ajit, Grover Sandeep, Kallivayalil Roy Abraham, Rai Yugesh, Shalbafan Mohammadreza, Chongsuksiri Pavita, Udomratn Pichet, Kathriarachchi Samudra T, Xiang Yu-Tao, Sim Kang, Javed Afzal, Chong Mian-Yoon, Tan Chay-Hoon, Lin Shih-Ku, Inada Toshiya, Murai Toshiya, Kanba Shigenobu, Sartorius Norman, Shinfuku Naotaka, Kato Takahiro A
机构信息
Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Preventive Services, School of Public Health/Medicine and Medical Science, Kyoto University, Kyoto, Japan.
出版信息
Psychiatry Investig. 2021 Nov;18(11):1058-1067. doi: 10.30773/pi.2021.0169. Epub 2021 Nov 5.
OBJECTIVE
Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists' attitude toward polypharmacy has been under debate.
METHODS
We developed an original questionnaire about Psychiatrists' attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide.
RESULTS
The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively).
CONCLUSION
Policy on polypharmacy may influence psychiatrists' decision-making. Thus, policies considering rational polypharmacy should be established.
目的
最近，尽管单药治疗风险较低且成本不高，但合理的联合用药方法仍被提出。将单药治疗视为一线治疗，联合用药视为合理治疗，建议对联合用药持平衡态度。然而，联合用药的高流行率促使日本政府制定了一项减少联合用药的政策。基于此，该政策与精神科医生对联合用药的态度之间的关联一直存在争议。
方法
我们编制了一份关于精神科医生对联合用药态度（PAP）的原创问卷。我们将PAP得分与临床病例 vignettes 中的治疗决策进行了比较。进行了多元回归分析，以量化包括政策因素和PAP得分在内的解释变量之间的关联。匿名问卷发放给了全球的精神科医生。
结果
该研究纳入了来自34个国家的347名精神科医生。对联合用药的决策与高PAP得分相关。多元回归分析显示，低PAP得分与政策因素相关（β = -0.20，p = 0.004）。韩国的文化与高PAP得分相关（β = 0.34，p < 0.001），而印度和尼泊尔的文化与低得分相关（分别为β = -0.15，p = 0.01和β = -0.17，p = 0.006）。
结论
联合用药政策可能会影响精神科医生的决策。因此，应制定考虑合理联合用药的政策。
Zotero 插件