Tinsley J A, Shadid G E, Li H, Offord K P, Agerter D C
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Gen Hosp Psychiatry. 1998 Nov;20(6):360-7. doi: 10.1016/s0163-8343(98)00049-8.
The purpose of this study was to compare the psychotropic prescribing practices of family physicians and psychiatric physicians, and to assess their satisfaction with education about psychotropic prescribing. A survey was mailed to 461 active members of the Minnesota Psychiatric Society and to a randomized sample of 461 active members of the Minnesota Academy of Family Physicians. Major depression, panic disorder, and dementia with behavioral disturbance were selected for study. For each disorder, we asked for the estimated number of patients seen and treated as well as a list in order of preference of the three medications they most commonly use. Those surveyed were also asked about their level of satisfaction with the training they received in medical school, residency, and continuing medical education (CME) courses on the topic of psychotropic prescribing. The two physician groups reported similar prescribing practices for the single-drug treatment of depression. Family physicians more frequently prescribed minor tranquilizers and older generation psychotropics than did psychiatrists when treating panic disorder and dementia with behavioral disturbance. Patients with depression were the least likely to be referred to other health professionals. Neither physician group was satisfied with medical school education in this area; family physicians were less satisfied with residency training and in related CME courses than were psychiatric physicians. Additional study is needed to better understand interspecialty practice variation for commonly encountered psychiatric disorders. Medical education programs at all levels could better meet the reported needs of their graduates by providing more attention to prescribing psychotropic agents.
本研究的目的是比较家庭医生和精神科医生的精神药物处方行为，并评估他们对精神药物处方教育的满意度。向明尼苏达精神医学会的461名活跃会员以及明尼苏达家庭医生学会的461名随机抽取的活跃会员邮寄了一份调查问卷。选取重度抑郁症、惊恐障碍以及伴有行为障碍的痴呆症进行研究。对于每种疾病，我们询问了所诊治患者的估计数量，以及他们最常用的三种药物的优先顺序清单。还询问了受访者对他们在医学院、住院医师培训以及关于精神药物处方主题的继续医学教育（CME）课程中所接受培训的满意度。两组医生在抑郁症单药治疗方面的处方行为相似。在治疗惊恐障碍和伴有行为障碍的痴呆症时，家庭医生比精神科医生更频繁地开具小剂量镇静剂和老一代精神药物。抑郁症患者被转诊至其他医疗专业人员的可能性最小。两组医生对该领域的医学院教育都不满意；家庭医生对住院医师培训及相关CME课程的满意度低于精神科医生。需要进一步研究以更好地理解常见精神疾病的跨专业实践差异。各级医学教育项目可以通过更多关注精神药物处方来更好地满足其毕业生报告的需求。
