Wong Jenna, Kurteva Siyana, Motulsky Aude, Tamblyn Robyn
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University.
Med Care. 2022 Jan 1;60(1):56-65. doi: 10.1097/MLR.0000000000001658.
Given the wide range of uses for antidepressants, understanding indication-specific patterns of prescription filling for antidepressants provide valuable insights into how patients use these medications in real-world settings.
The objective of this study was to determine the association of antidepressant prescription filling with treatment indication, as well as prior prescription filling behaviors and medication experiences.
This retrospective cohort study took place in Quebec, Canada.
Adults with public drug insurance prescribed antidepressants using MOXXI (Medical Office of the XXIst Century)-an electronic prescribing system requiring primary care physicians to document treatment indications and reasons for prescription stops or changes.
MOXXI provided information on treatment indications, past prescriptions, and prior medication experiences (treatment ineffectiveness and adverse drug reactions). Linked claims data provided information on dispensed medications and other patient-related factors. Multivariable logistic regression models estimated the independent association of not filling an antidepressant prescription (within 90 d) with treatment indication and patients' prior prescription filling behaviors and medication experiences.
Among 38,751 prescriptions, the prevalence of unfilled prescriptions for new and ongoing antidepressant therapy was 34.2% and 4.1%, respectively. Compared with depression, odds of not filling an antidepressant prescription varied from 0.74 to 1.57 by indication and therapy status. The odds of not filling an antidepressant prescription was higher among adults filling < 50% of their medication prescriptions in the past year and adults with an antidepressant prescription stopped or changed in the past year due to treatment ineffectiveness.
Antidepressant prescription filling behaviors differed by treatment indication and were lower among patients with a history of poor prescription filling or ineffective treatment with antidepressants.
鉴于抗抑郁药的用途广泛，了解抗抑郁药特定适应症的处方配药模式有助于深入了解患者在现实环境中如何使用这些药物。
本研究的目的是确定抗抑郁药处方配药与治疗适应症、既往处方配药行为及用药经历之间的关联。
这项回顾性队列研究在加拿大魁北克进行。
使用MOXXI（21世纪医疗办公室）开具抗抑郁药处方的成年公共药物保险患者，MOXXI是一个电子处方系统，要求初级保健医生记录治疗适应症以及处方停药或换药的原因。
MOXXI提供了治疗适应症、既往处方和既往用药经历（治疗无效和药物不良反应）的信息。关联的理赔数据提供了所配药物及其他患者相关因素的信息。多变量逻辑回归模型估计了未开具抗抑郁药处方（90天内）与治疗适应症、患者既往处方配药行为及用药经历之间的独立关联。
在38751张处方中，新抗抑郁药治疗和正在进行的抗抑郁药治疗未配药处方的患病率分别为34.2%和4.1%。与抑郁症相比，未开具抗抑郁药处方的几率因适应症和治疗状态而异，范围从0.74到1.57。在过去一年中配药不足50%的成年人以及过去一年因治疗无效而停用或更换抗抑郁药处方的成年人中，未开具抗抑郁药处方的几率更高。
抗抑郁药的处方配药行为因治疗适应症而异，在既往处方配药不佳或抗抑郁药治疗无效的患者中较低。
