青少年更安全地使用抗精神病药物研究》对人群水平抗精神病药物使用情况的评估:中断时间序列分析

IF 1.5 4区 医学 Q2 PEDIATRICS
Laura M West, Stephen J Mooney, Laura Chavez, Arne Beck, Gregory N Clarke, Chester J Pabiniak, Anne D Renz, Robert B Penfold
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引用次数: 0

摘要

背景:与其他精神药物相比,抗精神病药物的风险较高,可能会被开给患有其他一线治疗方法更合适的疾病的青少年。本研究旨在评估 "在青少年中更安全地使用抗精神病药物(SUAY)"试验在人群中的效果,该试验旨在减少参与者使用抗精神病药物的人日。研究方法我们使用分段回归法进行了中断时间序列分析,以衡量 2013 年至 2020 年间美国四个医疗系统在 SUAY 试验前和 SUAY 试验后抗精神病药物使用率处方趋势的变化。结果在我们的总体模型中,经年龄和保险类型调整后,SUAY 试验前每 10,000 人月的抗精神病药物处方启动率下降了 0.73(95% 置信区间 [CI]:0.30, 1.16,p = 0.002)。在试验开始后的第一季度,每万人月的抗精神病药物使用率立即下降了 6.57(95% 置信区间:0.99, 12.15)个处方。如果将试验后时期与试验前时期进行比较,每万人月的处方数增加了 1.09(95% CI:0.32,1.85)个,但仅在试验后时期的增加率在统计学上并不显著(每万人月 0.36 个处方,95% CI:-0.27,0.99)。结论2013 年至 2018 年(SUAY 试验前)期间出现的抗精神病药物启动率下降趋势可能已经自然达到了临床上有必要且适当的处方水平,从而产生了底线效应。COVID-19大流行始于试验后的最后三个季度,也可能与抗精神病药物用药量增加有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of the Safer Use of Antipsychotics in Youth Study on Population Level Antipsychotic Initiation: An Interrupted Time Series Analysis.

Background: Antipsychotics carry a higher-risk profile than other psychotropic medications and may be prescribed for youth with conditions in which other first-line treatments are more appropriate. This study aimed to evaluate the population-level effect of the Safer Use of Antipsychotics in Youth (SUAY) trial, which aimed to reduce person-days of antipsychotic use among participants. Methods: We conducted an interrupted time series analysis using segmented regression to measure changes in prescribing trends of antipsychotic initiation rates pre-SUAY and post-SUAY trial at four U.S. health systems between 2013 and 2020. Results: In our overall model, adjusted for age and insurance type, antipsychotic initiation rates decreased by 0.73 (95% confidence interval [CI]: 0.30, 1.16, p = 0.002) prescriptions per 10,000 person-months before the SUAY trial. In the first quarter following the start of the trial, there was an immediate decrease in the rate of antipsychotic initiations of 6.57 (95% CI: 0.99, 12.15) prescriptions per 10,000 person-months. When comparing the posttrial period to the pretrial period, there was an increase of 1.09 (95% CI: 0.32, 1.85) prescriptions per 10,000 person-months, but the increasing rate in the posttrial period alone was not statistically significant (0.36 prescriptions per 10,000 person-months, 95% CI: -0.27, 0.99). Conclusion: The declining trend of antipsychotic initiation seen between 2013 and 2018 (pre-SUAY trial) may have naturally reached a level at which prescribing was clinically warranted and appropriate, resulting in a floor effect. The COVID-19 pandemic, which began in the final three quarters of the posttrial period, may also be related to increased antipsychotic medication initiation.

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来源期刊
CiteScore
3.60
自引率
5.30%
发文量
61
审稿时长
>12 weeks
期刊介绍: Journal of Child and Adolescent Psychopharmacology (JCAP) is the premier peer-reviewed journal covering the clinical aspects of treating this patient population with psychotropic medications including side effects and interactions, standard doses, and research on new and existing medications. The Journal includes information on related areas of medical sciences such as advances in developmental pharmacokinetics, developmental neuroscience, metabolism, nutrition, molecular genetics, and more. Journal of Child and Adolescent Psychopharmacology coverage includes: New drugs and treatment strategies including the use of psycho-stimulants, selective serotonin reuptake inhibitors, mood stabilizers, and atypical antipsychotics New developments in the diagnosis and treatment of ADHD, anxiety disorders, schizophrenia, autism spectrum disorders, bipolar disorder, eating disorders, along with other disorders Reports of common and rare Treatment Emergent Adverse Events (TEAEs) including: hyperprolactinemia, galactorrhea, weight gain/loss, metabolic syndrome, dyslipidemia, switching phenomena, sudden death, and the potential increase of suicide. Outcomes research.
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