Scharf Tamara, Huber Carola A, Näpflin Markus, Zhang Zhongxing, Khatami Ramin
Graduate School of Health Sciences, University of Bern, Bern, Switzerland.
Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
JMIR Public Health Surveill. 2025 Jan 7;11:e53957. doi: 10.2196/53957.
Stimulants are potent treatments for central hypersomnolence disorders or attention-deficit/hyperactivity disorders/attention deficit disorders but concerns have been raised about their potential negative consequences and their increasing prescription rates.
We aimed to describe stimulant prescription trends in Switzerland from 2014 to 2021. Second, we aimed to analyze the characteristics of individuals who received stimulant prescriptions in 2021 and investigate the link between stimulant prescriptions and hospitalization rates in 2021, using hospitalization as a potential indicator of adverse health outcomes.
Longitudinal and cross-sectional data from a large Swiss health care insurance were analyzed from all insureds older than 6 years. The results were extrapolated to the Swiss general population. We identified prescriptions for methylphenidate, lisdexamfetamine, modafinil, and sodium oxybate and calculated prevalences of each drug prescription over the period from 2014 to 2021. For 2021 we provide detailed information on the prescribers and evaluate the association of stimulant prescription and the number and duration of hospitalization using logistic regression models.
We observed increasing prescription rates of all stimulants in all age groups from 2014 to 2021 (0.55% to 0.81%, 43,848 to 66,113 insureds with a prescription). In 2021, 37.1% (28,057 prescriptions) of the medications were prescribed by psychiatrists, followed by 36.1% (n=27,323) prescribed by general practitioners and 1% (n=748) by neurologists. Only sodium oxybate, which is highly specific for narcolepsy treatment, was most frequently prescribed by neurologists (27.8%, 37 prescriptions). Comorbid psychiatric disorders were common in patients receiving stimulants. Patients hospitalized in a psychiatric institution were 5.3 times (odds ratio 5.3, 95% CI 4.63-6.08, P<.001) more likely to have a stimulant prescription than those without hospitalization. There were no significant associations between stimulant prescription and the total length of inpatient stay (odds ratio 1, 95% CI 1-1, P=.13).
The prescription of stimulant medication in Switzerland increased slightly but continuously over years, but at lower rates compared to the estimated prevalence of central hypersomnolence disorders and attention-deficit/hyperactivity disorders/attention deficit disorders. Most stimulants are prescribed by psychiatrists, closely followed by general practitioners. The increased odds for hospitalization to psychiatric institutions for stimulant receivers reflects the severity of disease and the higher psychiatric comorbidities in these patients.
兴奋剂是治疗中枢性过度嗜睡症或注意力缺陷/多动障碍/注意力缺陷障碍的有效药物，但人们对其潜在的负面后果及其不断上升的处方率表示担忧。
我们旨在描述2014年至2021年瑞士兴奋剂的处方趋势。其次，我们旨在分析2021年接受兴奋剂处方的个体特征，并以住院作为不良健康结局的潜在指标，调查2021年兴奋剂处方与住院率之间的联系。
分析了来自瑞士一家大型医疗保险机构的6岁以上所有参保人的纵向和横断面数据。结果外推至瑞士总人口。我们确定了哌甲酯、赖氨酸安非他命、莫达非尼和羟丁酸钠的处方，并计算了2014年至2021年期间每种药物处方的患病率。对于2021年，我们提供了关于开处方者的详细信息，并使用逻辑回归模型评估兴奋剂处方与住院次数和住院时间的关联。
我们观察到2014年至2021年所有年龄组中所有兴奋剂的处方率均有所上升（从0.55%升至0.81%，有处方的参保人数从43,848人增至66,113人）。2021年，37.1%（28,057张处方）的药物由精神科医生开具，其次是36.1%（n = 27,323）由全科医生开具，1%（n = 748）由神经科医生开具。仅用于发作性睡病治疗的高度特异性药物羟丁酸钠，最常由神经科医生开具（27.8%，37张处方）。接受兴奋剂治疗的患者中常见合并精神疾病。在精神病院住院的患者开具兴奋剂处方的可能性是未住院患者的5.3倍（优势比5.3，95%置信区间4.63 - 6.08，P <.001）。兴奋剂处方与住院总时长之间无显著关联（优势比1，95%置信区间1 - 1，P = 0.13）。
瑞士多年来兴奋剂药物的处方量略有但持续增加，但与中枢性过度嗜睡症和注意力缺陷/多动障碍/注意力缺陷障碍的估计患病率相比，增长率较低。大多数兴奋剂由精神科医生开具，紧随其后的是全科医生。接受兴奋剂治疗的患者入住精神病院的几率增加，反映了这些患者疾病的严重性和较高的精神疾病合并症。
