Pharoah P D, Melzer D
Department of Health Policy and Public Health, Cambridge and Huntingdon Health Commission, Fulbourn Hospital.
Br J Gen Pract. 1995 Nov;45(400):595-9.
Although the desirability of reducing prescribing of hypnotics and anxiolytics has long been recognized, variation between practices in patterns of psychotropic drug prescribing has received little attention; factors underlying such variation are poorly understood.
The study aimed to describe the extent of variation between general practices in the prescribing of hypnotics, anxiolytics and antidepressants; it also aimed to analyse the influence of measures of practice population and general practice and general practitioner characteristics on any variation in prescribing volumes.
Routinely collected prescribing data and practice population data, from April 1992 to March 1993, from all 61 practices in the Cambridge and Huntingdon Health Commission were analysed. Prescribing was measured as annual defined daily doses per 1000 practice population for each drug class. Data on variables relating to practice structure and general practitioner characteristics were obtained and analysed. Potentially influencing variables were investigated by multiple regression.
Between the highest and lowest prescribing practices there was an 11-fold difference, a 13-fold difference and an eightfold difference in the annual defined daily doses per 1000 practice population prescribed for hypnotics, for anxiolytics and for antidepressants, respectively. Strong positive correlations existed between volumes of prescribing of each drug class. The drugs prescribed in the greatest volumes were hypnotics. Practice population structure had some influence on psychotropic drug prescribing with high prescribing being associated with the proportions of temporary residents and women aged 65 years and over in the practice for all three classes of drug. Other factors, including presence of a practice counsellor, were not found to have a significant influence on psychotropic drug prescribing.
The degree of variation in prescribing volumes of psychotropic drugs between practices raises serious concerns. Further study is needed, but progress will be hampered until there is more clarity over the effectiveness and appropriateness of using these substances in the various illness, symptom and life-stress presentations seen in primary care.
尽管人们早就认识到减少催眠药和抗焦虑药处方的必要性，但精神药物处方模式在不同医疗机构之间的差异却很少受到关注；对这种差异背后的因素也知之甚少。
本研究旨在描述不同全科医疗诊所之间催眠药、抗焦虑药和抗抑郁药处方的差异程度；还旨在分析诊所人口数量指标以及全科医疗诊所和全科医生特征对处方量差异的影响。
对1992年4月至1993年3月期间剑桥和亨廷顿健康委员会的所有61家诊所常规收集的处方数据和诊所人口数据进行分析。处方量以每1000名诊所人口每年的限定日剂量来衡量每种药物类别。获取并分析了与诊所结构和全科医生特征相关变量的数据。通过多元回归研究潜在影响变量。
在处方量最高和最低的诊所之间，每1000名诊所人口每年的限定日剂量，催眠药相差11倍，抗焦虑药相差13倍，抗抑郁药相差8倍。每种药物类别的处方量之间存在强正相关。处方量最大的药物是催眠药。诊所人口结构对精神药物处方有一定影响，在所有三类药物的诊所中，高处方量与临时居民以及65岁及以上女性的比例相关。未发现其他因素，包括诊所顾问的存在，对精神药物处方有显著影响。
不同诊所之间精神药物处方量的差异程度令人严重担忧。需要进一步研究，但在初级保健中所见的各种疾病、症状和生活压力情况下使用这些药物的有效性和适当性更加明确之前，进展将受到阻碍。
