一项全国性的养老院临床医生调查解释了增加的瓦尔酸处方
Jonathan D Winter1, J William Kerns1, Danya M Qato2
1Virginia Commonwealth University School of Medicine (JDW, JWK, CW, SRR, AHK), Department of Family Medicine and Population Health, Richmond, VA; Shenandoah Valley Family Practice Residency (JDW, JWK), Front Royal, VA.
养老院医生越来越多地为精神症状开处方瓦尔酸, 往往是为了减少其他精神药物. 由于未经监测的抗发作药物使用,这一趋势引发了安全问题.
科学领域:
- 老年精神病学
- 药理学
- 医疗服务研究
背景情况:
- 瓦尔酸是一种抗发作药物 (ASM),已被批准用于发作,双相躁狂和偏头痛预防.
- 由于不清楚的原因,它在养老院 (NHs) 越来越多,与ASM的新强制性报告相吻合.
研究的目的:
- 调查养老院的临床医生,了解瓦尔酸的处方原因及其越来越多的使用.
- 确定导致NH中氨酸处方增加的因素.
主要方法:
- 对美国159名养老院临床处方医生 (医生和高级实践提供者) 的全国横截面调查.
- 这项匿名调查是通过SurveyMonkey进行的,采用试点数据和文献.
主要成果:
- 97% 的临床医生报告说,在治疗精神症状时使用非标签的氨酸会导致患病率增加.
- 减少抗精神病药物和二类药物的努力,少见的剂量减少,人员短缺和有限的非药物干预措施是主要原因.
- 临床医生普遍认为氨酸风险低至中等,对NH患者的精神症状有效.
结论:
- 人们认为NH瓦尔酸盐使用的增加主要是标签外的,可能是为了控制精神症状,同时避免对其他精神药物的审查.
- 针对高风险精神药物减少的政策可能无意中导致未经监测的ASM增加,安全性和有效性不确定.
- 目前尚不确定新的ASM报告任务是否能够解决这些监管缺口.
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