精神科思覺失調症病人之處方型態分析

目的：以全民健康保險研究資料庫分析思覺失調症病人處方型態，為提供而後醫療人員治療思覺失調症病人參考。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，分析處方藥品品項情形，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：研究樣本篩選結果共納入2,486人進行處方型態分析。2006~2010年總發生人次男性1,231人及女性為1,255人，兩者間並無統計學上的差異（P=0.369）。思覺失調症的發生並無性別上的差異。以年齡級距加以分析，由就診人次分佈統計思覺失調症好發年齡為30~44歲（42.08%）。2007~2010年思覺失調病人初次處方納入分析之總人次共為855人。其中處方包含有一個抗精神病類藥物(APM）之總處方人次為833人（97.43%），未開立者為22人（2.57%）。處方平均開立藥品數目為2.7個。其次再以處方藥物筆數進行分類，處方藥物筆數為2者為236人佔最多數（27.6%），其次分別為3筆200人（23.4%）及1筆193人（22.6%）。就診之醫院層級分析，2007-2010年間以區域醫院373人（43.63%）為最高。藥物類別分析，處方筆數為1筆者以抗精神病類藥物治療者共178人，以N05AX-other antipsychotic 90人（50.56%）為最多。單一處方藥物於不同醫院層級皆以Risperidone（N 05AX08）最多，共65人（33.68%），前五大單一處方藥品中，只有Sulpiride為第一代的APM，其餘皆為第二代。2種藥品之處方型態共有10種，以Antipsychotics 及Hypnotics and sedatives [(N05A) +(N05C)]最多（82張; 34.75%）。只有3種藥品的處方型態共20多類，其中以Antipsychotics, Hypnotics and sedatives及Anticholinergicagents [(N05A) + (N05C) + (N04A)]的型態共45張最多（22.50 %）。以2筆處方型態來看，合併使用於副作用的控制治療[(N05A) +(N04A), (N05A) + (N05B), (N05A) + (C07B), (N05A) + (A06A)]逹109人（46.19%）。結論：本研究結果顯示經初次診斷為思覺失調病人（ICD-9: 295）約有2.57%病人之治療處方並未開立相關抗精神病藥物。醫師處方治療藥物多以1-3種藥物治療為主（73.6%）。2種藥品之處方形態以Antipsychotics及Hypnotics and sedatives [(N05A) + (N05C)]最多，3種藥品的處方型態中以Antipsychotics, Hypnotics and sedatives併用Anticholinergic agents [(N05A) + (N05C) + (N04A)]的型態最多。

關鍵字

思覺失調症；處方型態；健保資料庫研究

並列摘要

Objective This study was to investigate the prescribing patterns of Schizophrenia patients and present the incidence of schizophrenia ( ICD-9-CM 295 ) in Taiwan. The aim was to offer evidenced-based data for prescribing medical selection. Background Schizophrenia is among the most disabling and economically catastrophic medical disorders, ranked by World Health Organization as one of the top ten illnesses contributing to the global burden of disease. Antipsychotic drugs are first-line treatment for schizophrenia; however, antipsychotics differ widely in their side effect profiles, influencing drug selection. Because of the complex medical selection for individuals, this study investigated the prescription of medications to treat Schizophrenia under NHI in Taiwan. Subjects and methods The data for 2006 to 2010 were collected from the NIHD. The dataset contains information about 1,000,000 beneficiaries randomly sampled from the year 2006 registry for beneficiaries of the NHIRD. The subjects were grouped by age classified in to one of five categories and identified based on major diagnoses of ICD-9-CM codes 295 ( included the first diagnostic code 295 without second or third code). Result Subjects based on the ID included were 2,486(male 1,231 and female 1,255) in 2006~2010. The incidence of male and female was no statistical difference (P = 0.369).The analysis of initial prescription items of Schizophrenia patients in 2007~2010 shows the patients with any one of antipshychotics or without any one were 97.43% and 2. 57%. The average numbers of drugs for prescribing patterns were 2.7.The incidence of schizophrenia (ICD-9-CM:295) grouping by age gap,<18, 18-29, 30-44, 45-64, and 65 or more years were 2.37%, 19.03%, 42.08%, 31.74% and 4.79%. The rate of the medication analysis of the initial diagnosis prescriptions –one drug, two drug, and three drug separately were 23%, 29%, 23%. There were most of patients to Schizophrenia therapy in Metropolitan Hospitals, 373 persons (43.63%), in 2007-2010. The most prescribing patterns of one drug were N05AX-other antipsychotic, 90 persons (50.56%) The prescribing patterns of two drugs for the treatment of adverse effect were [(N05A) +(N04A), (N05A) + (N05B), (N05A) + (C07B), (N05A) + (A06A)] and total subjects were 109 persons (46.19%). Conclusions 　The results of this study shows that after the initial diagnosis of psychosis patients (ICD-9: 295), about 2.57% of patients in the treatment of prescription without antipsychotic. The medications of prescription were 1~3 drugs. (73.6%). The type of drugs to be most prescribed in two drugs group were Antipsychotics and Hypnotics and sedatives [(N05A) + (N05C)]. There was Antipsychotics, Hypnotics and Sedatives and Anticholinergic agents [(N05A) + (N05C) + (N04A)] in three drugs group.

並列關鍵字

schizophrenia ； prescribing patterns ； population-based study

參考文獻

1. Nicholl D, Akhras KS, Diels J, Schadrack J. Burden of schizophrenia in recently diagnosed patients:healthcare utilization and cost prespective. Curr Med Res Opin, 2010; 26(4): 943.

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