精神科住院病人抗精神病藥物五年期間處方型態研究

A Retrospective Study on the Prescribing Patterns of Antipsychotic Drugs for Inpatients with Psychosis in a Psychiatric Hospital during 2017-2021

目的：近年健保藥費管理措施持續調整，第一代與第二代抗精神病藥物藥價差縮小，本研究欲了解醫院2017-2021年間抗精神病藥物處方型態（單複方、日劑量）及其年度別間之差異情形。方法：資料來源為2017年至2021年醫院住院健保月申報資料，個案納入條件為2017-2021年間每年至少需有一筆月申報資料者；排除條件為同次住院期間抗精神病藥物的使用天數小於14天者，共篩選出843人（月申報數47,344月人次）。結果：2017年抗精神藥物單方處方率82.1%，2018、2019、2020及2021年單方處方率比2017年少2%、2%、3%、3%（p<0.01）。各年度第一代抗精神病藥物被處方率皆比2017年下降（p<0.05）。2017年第一代與第二代抗精神病藥物混合處方比率17.4%，2019-2021年第一代與第二代抗精神病藥物混合處方比率皆比2017年高（p<0.05）。2017年抗精神病藥物劑量日劑量為2.93DDD，2018、2019及2021年抗精神病藥物劑量分別比2017年少0.06、0.23、0.26（p<0.05）。結論：本研究收錄個案為住院病人，經由醫療人員提供相關治療活動，隨著發病年增長，服用多重抗精神病藥物比率增加，但抗精神病藥物劑量並未隨著增加。

Objectives. In recent years, the price gap between first-generation and second-generation antipsychotic drugs has narrowed due to the continued adjustment of the National Health Insurance Administration's drug cost management regulations. This study aims to understand the prescription patterns of antipsychotic drugs (single vs. combination therapy, daily dosage) in our hospital from 2017 to 2021, as well as the differences across the years.
Methods. The data source is the monthly healthcare insurance claims data from our hospital during 2017 to 2021. Inclusion criteria for cases were that there must be at least one monthly claim record each year from 2017 to 2021. Exclusion criteria included cases where the duration of antipsychotic medication use during the same hospitalization was less than 14 days. A total of 843 patients were screened (with 47,344 monthly claims).
Results. In 2017, the monotherapy prescription rate for antipsychotics was 82.1%. For the years 2018, 2019, 2020, and 2021 , these rate were lower than in 2017 by 2%, 2%, 3%, and 3%, respectively (p<0.01). The prescription rate of first-generation antipsychotic drugs decreased each year compared to 2017 (p<0.05). In 2017, the rate of mixed prescriptions of first-generation and second-generation antipsychotic drugs was 17.4%. Between 2019 and 2021, these rates were significantly higher than those in 2017 (p<0.05). The daily dosage of antipsychotic drugs in 2017 was 2.93 DDD, which decreased by 0.06, 0.23, and 0.26 in 2018, 2019, and 2021 (p<0.05).
Conclusion. This study mainly involved inpatients , and through the treatment activities provided by healthcare professionals, it was found that as the years of illness increased, the rate of polypharmacy also increased; however, the dosage of antipsychotic drugs did not increase correspondingly.