台灣精神科門診妄想型精神分裂症病人之處方型態分析

Prescribing Pattern of Paranoid Type Schizophrenia for Psychiatry Patients in Ambulatory Care in Taiwan

黃榮焜(Zong-Kung Huang)

指導教授 ： 吳信昇

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2014年)

摘要

目的：以全民健康保險研究資料庫分析各種妄想型精神分裂症病人處方的型態，為 供而後醫療人員治療妄想型精神分裂症病人參考。
方法：本研究為回溯性的資料分析，資料來源為2006年至2010年全民健保醫療院所 門診申報資料，篩選出初次且單一診斷碼的精神分裂症(ICD-9診斷碼 295)病人。2007~2010的研究樣本有855人，再從此研究樣本中找出各種妄想型精神分裂症(ICD -9診斷碼分別為295.31、295.32、295.33、295.34和295.35)的病人，接著再從研究樣本找出開立診斷時其醫師處方的藥品品項情形，藥品品項依WHO ATC code system之分類來探討其處方藥品品項型態，整理出其趨勢以供而後醫療人員參考。
結果：符合精神科門診初次(排除2006年)且單一診斷碼的病人，在2007至2010年合計206人，其人數依其ICD -9診斷碼295.31、295.32、295.33、295.34和295.35分別有25、69、19、85和8人，其中以295.34的病人最多，其次為295.32的病人。性別為男性102人 (49.5%)、女性104人 (50.5%)，其就醫層級以醫學中心35人(17.0%)、區域醫院101人(49.0%)、地區醫院55人(26.7%)、診所15人(7.3%)，顯示妄想型精神分裂症病人初次精神科門診最多選擇在區域醫院。其年齡分布在13~17歲5人(2.4%)，18~29歲37人(18.0%)，30~44歲85人(41.3%)， 45~64歲65人(31.6%)、65歲以上14人(6.8%)，顯示妄想型精神分裂症病人初次精神科門診其年齡分布在30~44歲最多。針對妄想型精神分裂症單一診斷碼處方箋，其開立之處方藥品項總數為591個，每張處方開立藥品數目型態有9種(1藥品/張、2藥品/張、3藥品/張、4藥品/張、5藥品/張、6藥品/張、7藥品/張、8藥品/張和10藥品/張)，每張處方開立藥品數目型態最多前3種依序為2藥品/張(49張; 23.8%)、3藥品/張(48張; 23.3%)、1藥品/張(46張; 22.3%)。每張處方平均開立藥品數目為2.869個，每張處方平均開立抗精神病類(N05A)藥品數目為1.131個。只有2種藥品的處方型態有11類，以antipsychotics hypnotics and sedatives [(N05A) + (N05C)]最多(18張; 37%)、其次antipsychotics and anticholinergic agents [(N05A) + (N04A)] (16張; 33%)、再次antipsychotics and anxiolytics [(N05A) + (N05B)] (6張; 12%)。只有3種藥品的處方型態多至20類，其中以antipsychotics, hypnotics and sedatives and anticholinergic agents[(N05A) + (N05C) + (N04A)]的型態最多(13張; 27%)、其次antipsychotics,hypnotics and sedatives and anxiolytics [(N05A) + (N05C) + (N05B)] (8張;17%)、再次antipsychotics, anticholinergic agents and anxiolytics [(N05A) + (N04A) + (N05B)] (6張; 13%)。只有1種藥品的處方型態僅有2類， 最多為antipsychotics [(N05A)] (43張; 93%)、其次為anxiolytics [(N05B)] (3張; 7%)。
使用藥品與診斷碼有統計意義有：haloperidol、amisulpride，與年齡分組有統計意義有：biperiden，與性別有統計意義有：risperidone，與醫療機構層級有統計意義有：estazolam、sulpiride、amisulpride。其中，haloperidol在295.34使用最多，佔整體295.34的20.00%、amisulpride在295.32使用最多，佔整體295.32的14.49%。biperiden在最年輕分組使用最多，佔整體最年輕分組的60.00%。risperidone在女性使用最多，佔整體女性的36.54%。estazolam在區域醫院使用最多，佔整體區域醫院的35.64%。sulpiride在診所使用最多，佔整體診所的33.33%。amisulpride在醫學中心使用最多，佔整體醫學中心的20.00%。
使用藥品與處方箋上藥品數目有統計意義有：trihexyphenidyl HCl (N04A), estazolam (N05C), lorazepam (N05B), biperiden HCl (N04A), clonazepam (N03A), quetiapine fumarate (N05A), clozapine (N05A), propranolol HCl (C07A), alprazolam (N05B), aripiprazole (N05A), valproate sodium (N03A)。
結論：初次且無其他共病的妄想型精神分裂症(295.31~295.35)，其主要處方箋的型態如下：2種藥品者為antipsychotics hypnotics and sedatives [(N05A) +(N05C)],3種藥品者為antipsychotics, hypnotics and sedatives and anticholinergic agents[(N05A) + (N05C) + (N04A)]，1種藥品者為antipsychotics [(N05A)]。其使用藥品與處方箋上藥品數目有統計意義者有：trihexyphenidyl HCl (N04A), estazolam (N05C), lorazepam (N05B), biperiden HCl (N04A), clonazepam (N03A), quetiapine fumarate (N05A), clozapine (N05A), propranolol HCl (C07A), alprazolam (N05B), aripiprazole (N05A), valproate sodium (N03A)。

關鍵字

妄想型精神分裂症 ； 處方的型態 ； 健保資料庫

並列摘要

Objectives: This is a retrospective, population-based study on the prescribing pattern of paranoid type schizophrenia for psychiatry patients in ambulatory care in Taiwan.
Methods: The insurance outpatient claims data obtained from the National Health Insurance in Taiwan from 2006 to 2010. A total of 206 patients with diagnosis of paranoid type schizophrenia (ICD-9-CM 295.31~295.35) were qualified. Next, we identified the first psychiatric outpatient paranoid type schizophrenia prescription between 1 July 2007 and 31 December 2010, and we focus on analyzing the first paranoid type psychiatric prescription. We analyzed the prescriptions of those population based on the number of drugs in prescription and WHO ATC code system for drug.

Results: The study showed that patients of paranoid type schizophrenia were 206 persons in 2007~2010. Based on ICD-9-CM, 206 persons were classified as 295.31, 25 persons; 295.32, 69 persons; 295.33, 19 persons; 295.34, 85 persons; 295.35, 8 persons. Gender male 102 (49.5%), 104 females (50.5%). According to drug item number in a prescription, there were 9 kinds of prescribing pattern of paranoid type schizophrenia for psychiatry patients in ambulatory care. The top three of this prescribing pattern were 2 drug/prescription(49; 23.8%), 3 drug/prescription(48; 23.3%) and 1 drug/prescription(46; 22.3%), respectively. Prescribing patterns of 2 drug/prescription based on ATC code were 11 kinds. Antipsychotics, hypnotics and sedatives [(N05A) + (N05C)] (18; 37%), antipsychotics, anticholinergic agents [(N05A) + (N04A)] (16; 33%), antipsychotics, anxiolytics [(N05A) + (N05B)](6;12%) were the top three in 2 drug/prescription pattern, respectively. Prescribing patterns of 3 drug/prescription based on ATC code were 20 kinds. Antipsychotics, hypnotics and sedatives, anticholinergic agents [(N05A) + (N05C) + (N04A)] (13; 27%), antipsychotics, hypnotics and sedatives, anxiolytics [(N05A) + (N05C) + (N05B)] (8; 17%), antipsychotics, anticholinergic agents, anxiolytics [(N05A) + (N04A) + (N05B)] (6; 13%) were the top three in 3 drug/prescription pattern, respectively. Prescribing patterns of 1 drug/prescription based on ATC code were 2 kinds. One was antipsychotics [(N05A)] (43; 93%), the other was anxiolytics [(N05B)] (3; 7%).
Haloperidol was usually used (20.00%) in 295.34 and amisulpride was often used (14.49%) in 295.32. Biperiden was major used (60.00%) in the most young age group. Risperidone was regularly used (36.54%) in female. Estazolam, sulpiride and amisulpride were frequently in regional hospital (35.64%), clinic (33.33%) and medical center (20.00%), respectively.

Conclusions: The top three prescribing patterns in newly diagnosed and no other comorbid paranoid type schizophrenia were (1) antipsychotics, hypnotics and sedatives [(N05A) + (N05C)], (2) antipsychotics, hypnotics and sedatives and anticholinergic agents [(N05A) + (N05C) + (N04A)], (3) antipsychotics [(N05A)].

並列關鍵字

paranoid type schizophrenia ； prescribing patterns ； population-based study

參考文獻

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