PowerPoint Slideshow about ' 分析抗焦慮劑 / 安眠劑之使用的影響因子在重度憂鬱症及廣泛性焦慮症病人和一般大眾的處方形態' - fritz
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Background: Benzodiazepines (BZDs) or benzodiazepine receptor agonists, also called Z-drugs (e.g. zolpidem, zopiclone or zaloplon), have anxiolytic and hypnotic functions to relieve symptoms among major depressive disorder (MDD) and generalized anxiety disorder (GAD) patients. The concerns of using anxiolytic and hypnotic agents are tolerance, dependence, accident proneness, and increased risk of falls in elderly. Thus, these agents should be used only in the acute phase, indicated by treatment guidelines. Factors associated with the use of these agents have been studied within whole population, especially in the elderly. However, the factors have not been studied in MDD and GAD patients. Taiwan’s government authority implemented the guideline in 2005. Whether physicians would have followed this guideline to prescribe BZDs, is still unknown.
Objective: The goal was to investigate the use of anxiolytic/hypnotic agents in the MDD and GAD patients and to compare the prescription pattern of anxiolytic/hypnotic agents in National Health Insurance Research Database (NHIRD) 2004 and 2006 in Taiwan.
Methods: The data of this study were obtained from NHIRD (for 2004 to 2006; 1,000,000 people per year) and TMU-Wan Fang Medical Center database (T-WFMCD) during 2004 to 2009. In the first part of this study, patients who were diagnosed of either MDD or GAD at clinics were selected, and those who had other medical conditions (e.g. seizures or other CNS disorders) that affect the duration of hypnotic-use were excluded. Patients who had finished their antidepressant treatment with doctor’s guide were included in T-WFMCD group. Univariate regression models were performed to select the significant correlated factors with the use of anxiolytic/hypnotic agents. Then backward stepwise multivariate regression models were performed to analyze the factors with the more powerful effect on the use of anxiolytic/hypnotic agents among these significant correlated factors. In the second part of this study, the data were based on the 1,000,000 people in 2004 and 2006 NHIRD. The numbers of patients who received the BZD prescriptions in chronic use were collected for comparison of the prescription pattern in pre- and post-guideline year. Chi-square test was used for testing the statistic difference.
Results: In the first part of this study, 17,226 patients were diagnosed of MDD and/or GAD during 2004 to 2006. The sum of 8,902 and 9,334 patients were diagnosed as MDD and GAD, respectively in these three years. A total of 1,010 patients were comorbid with both MDD and GAD. After fulfilling the inclusion and exclusion criteria, 399 patients were included into NHIRD group. 63 patients were included into T-WFMCD group. The antidepressant-prescribing days, and the number of antidepressants used were found to be significantly correlated in both databases. Age and the four month or more of the use of anxiolytic/hypnotic agents before antidepressant therapy were found to be significantly correlated in NHIRD group., Based on the 1,000,000 patient population in the second part of this study, the overall numbers of patients who received the BZD prescriptions in chronic use were found to be increased significantly from 11,039 to 16,193 in 2004 to 2006. And the numbers of patients who received more than 30 days of BZDs were increased significantly from 6,505 to 8,790. While the numbers of patients with less than 30 days of BZDs were found to be increased significantly from 4,534 to 7,401.
Conclusion: The results of present study suggested that the antidepressant-prescribing days, and the numbers of antidepressants used are significant associated with the use of anxiolytic/hypnotic agents. And age and the four month or more of the use of anxiolytic/hypnotic agents have significant association in NHIRD group. After the publication of the guideline, the BZDs prescriptions in 2006 have been found to be significantly increased over the pre-guideline year of 2004. Apparently the prescription pattern of BZDs by Taiwanese physicians was not changed by the publication of the 2005 guideline of the management and use of BZDs.