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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 林珍芳 | |
dc.contributor.author | Yun-Ning Tseng | en |
dc.contributor.author | 曾韻寧 | zh_TW |
dc.date.accessioned | 2021-06-17T04:58:42Z | - |
dc.date.available | 2023-08-01 | |
dc.date.copyright | 2018-08-01 | |
dc.date.issued | 2018 | |
dc.date.submitted | 2018-07-26 | |
dc.identifier.citation | 1. Laursen, T. M., Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophrenia research 2011, 131 (1), 101-104.
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/71208 | - |
dc.description.abstract | 研究目的
分析2002-2012年間新診斷且新治療的思覺失調症患者診斷後一年內藥品使用狀況是否隨著年代而有顯著的變化,以及分析不同用藥方式與患者背景特性間的關係,來探討醫師開出的第一筆處方的原因,以說明什麼樣的特徵會影響患者的藥品形式,來解釋用藥選擇背後的成因。由於不同國家間的用藥方式不盡相同,究竟台灣新診斷且新治療的思覺失調症患者使用抗精神病藥物於這些年的變化趨勢以及背後的原因是一個值得探討的問題。 研究方法 使用2000年1月1日至2013年12月31日之臺灣全民健康保險資料,於2002年1月1日至2012年12月31日初次被診斷為思覺失調症,且為初次使用抗精神病藥物之就醫記錄者,及需大於18歲,並進行一年藥品使用的追蹤。分析患者於診斷後一年內的歷年藥品使用狀況的趨勢分析,使用multivariate logistic regression以及Spearman’s partial rank correlation test,以評估變項是否隨著時間而有特別的變化趨勢。為了解釋用藥選擇背後的成因,藉由multinomial logistic regression進行分析,以說明什麼樣的特徵會影響患者的用藥方式。此外,亦分析不同用藥方式造成的後續住院狀況是否有所不同,以探討什麼樣的用藥方式療效較好,並解釋用藥趨勢背後的原因。 結果與討論 2002至2012年間,患者於診斷後第一筆抗精神病藥物的開方趨勢有明顯的變化,FGAs由77.8%下降至32.9%, SGAs的使用量則從29.8%上升至81.9%。隨著用藥趨勢的改變,為了減輕抗精神病藥物的副作用造成錐體外症候群而使用抗膽鹼藥品的比例由78.9%下降至49.7%,此結果與FGAs使用量大幅下降有著密切的關係。患者所在的醫院層級對於開方的影響很大,於醫學中心就診的患者中,第一筆開方單獨使用SGAs的比例為57.6%,FGAs則為 29.1%,然而隨著醫院層級的降低,發現到基層診所SGAs的使用量下降至36.0%,反之,FGAs則大幅則增加至59.6%,表示醫院層級較高的醫院較傾向開出SGAs之處方。需特別注意的是,醫生似乎不太會因為患者的共病症而影響開方。而初次開方為單獨使用SGAs的患者,其住院率與後續住院天數都比單獨使用FGAs的來的低,可能是因為SGAs的療效較好,藉此解釋用藥趨勢背後的原因。 結論 於2002-2012年研究期間,SGAs逐漸取代FGAs成為治療新診斷且新治療思覺失調症的主要用藥。隨著用藥趨勢的改變,FGAs使用量的下降使得治療錐體外症候群的抗膽鹼藥品的使用比例有下降的趨勢。而患者所在的醫院層級對於藥品的選擇扮演重要的角色,但不太會因為患者的性別、年齡與共病症而影響開方。此外,由於SGAs的使用量增加,其療效、藥物副作用與成本需加以評估。 | zh_TW |
dc.description.abstract | Purpose
This study aimed to describe the patterns in antipsychotic prescription of newly treated and diagnosed with schizophrenia from 2002 to 2012, and analyzed the trend in the first-year pharmacological treatment of newly diagnosed and treated schizophrenia patients. To explore the reason behind the trends in treatment, we also examined which baseline characteristic influenced the first antipsychotics prescription. Every country has different prescription pattern. Therefore, trends in the first-year pharmacological treatment of newly treated and diagnosed with schizophrenia patients in Taiwan and its reasons are important questions. Method The data source was Taiwan National Health Insurance Research Database (2000-2013). The study identified all schizophrenic patients aged 18 years and older who were newly diagnosed between January 1, 2002 and December 31, 2012. We excluded subjects who had antipsychotics treatment before schizophrenia diagnosis. The following-up time for each patient was one year. Changes in the first year of treatment were assessed by multivariate logistic regression and Spearman’s partial rank correlation. Multinomial logistic regression was used to analyze the relation between different antipsychotics and characteristics of the patients and to explain the reason behind the trends in treatment. In addition, to explore the efficacy of antipsychotics, we examined patients’ hospitalization in different prescription pattern. Result and Discussion The percentage of prescriptions of SGAs increased from 29.8% to 81.9%; however, FGAs declined from 77.8% to 32.9%. As a result of the change of the trend of antipsychotic prescription, the percentage of anticholinergic agents decreased from 78.9% to 49.7%. Different hospital level would influence prescription. The percentage of prescriptions of SGAs and FGAs were 57.6% and 29.1% in academic medical center respectively. With the declined of hospital level, the use of SGAs decreased to 36.0% but the use of FGAs increased to 59.6% in clinic. However, it should be noticed that prescriptions were not influenced by patient’s comorbidity. Besides, patients who used SGAs had lower hospitalization rate and average hospitalization days, it may due to SGAs’ great efficacy. Conclusion In the first-year treatment of newly treated patients with a diagnosis of schizophrenia between 2002 and 2012, SGAs replaced FGAs as the first choice for therapy. With the change of the trend of antipsychotics prescription, the percentage of anticholinergic agents decreased due to decreasing of FGAs. Hospital level played an important role in the selection of antipsychotics, but patient’s gender, age and comorbidity didn’t influence prescription. Moreover, drug efficacy, side effect and cost of the changes due to the increasing trends in prescribing SGAs should be further investigate | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T04:58:42Z (GMT). No. of bitstreams: 1 ntu-107-R05423023-1.pdf: 6186035 bytes, checksum: a8e27ee05ee68be60a4fc422d57fd523 (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | 口試委員審定書 i
謝辭 ii 中文摘要 iii abstract v 目錄 vii 圖目錄 xi 表目錄 xii 附錄目錄 xiii 第一章 前言 1 1.1研究背景與現況 1 1.2研究目的 1 第二章 疾病簡介 3 2.1流行病學 3 2.2病理機轉 3 2.3危險因子 4 2.4疾病診斷 4 2.5臨床表徵 4 第三章 疾病治療 5 3.1藥物治療 5 3.1.1 第一代抗精神病藥物 5 3.1.2第二代抗精神病藥物 5 3.2社會心理治療 6 3.3 病患特性與抗精神病藥物用藥 6 第四章 研究方法 8 4.1資料來源 8 4.2 研究設計 8 4.2.1研究對象 8 4.2.2.排除條件 8 4.2.3追蹤期間 9 4.2.4研究對象之基本資料分析 9 4.2.5抗精神病藥物的使用 9 4.2.6藥物順從性 10 4.2.7患者特性趨勢分析 11 4.2.8後續共用藥物趨勢分析 11 4.2.9用藥方式與患者特性之分析 12 4.2.10住院趨勢分析 12 4.2.11敏感性分析 13 4.3資料分析 13 4.3.1研究對象基本特性分析 13 4.3.2使用抗精神病藥物之分析 13 4.3.3醫院層級對於抗精神病藥物的影響分析 14 4.3.4劑型分析 14 4.3.5趨勢分析 14 4.3.6用藥方式與患者特性之分析 15 4.4統計分析 15 4.4.1研究對象背景資料趨勢分析 15 4.4.2後續治療趨勢分析 16 4.4.3用藥方式與患者特性之分析 17 第五章 結果 18 5.1思覺失調症患者特性 18 5.2 使用FGAs與SGAs患者特性分析 18 5.3 抗精神病藥物使用趨勢 20 5.4性別與抗精神病藥物之分析 20 5.5藥品選擇與年齡層分析 21 5.6使用抗精神病藥物患者之共病藥分析 21 5.7 醫院層級分析 21 5.8 劑型分析 22 5.9患者特性趨勢分析 23 5.10患者後續治療趨勢分析 23 5.11用藥方式與患者背景特性分析 24 5.12初次用藥與後續住院之關係 25 5.13後續用藥方式與後續住院之關係 26 5.14敏感性分析 27 5.14.1更改研究對象納入條件 27 第六章 討論 28 6.1 患者特性 28 6.2 抗精神病藥物的使用狀況 28 6.3抗精神病藥物的選擇 29 6.4醫院層級的影響 29 6.5歷年趨勢分析 30 6.5.1患者特性趨勢分析 30 6.5.2抗精神病藥物使用趨勢分析 30 6.5.3共用藥物趨勢分析 31 6.6用藥方式與患者特性 32 6.7住院分析 33 6.8藥品使用與後續住院之分析 33 6.9研究限制 34 6.10研究重要性 35 第七章 結論與未來應用 37 7.1圖表 38 7.1.1 圖 38 7.1.2 表 49 7.2附錄 82 參考文獻 96 圖目錄 圖 1研究設計 38 圖 2 研究設計流程圖 39 圖 3初次使用FGAs與SGAs的歷年百分比 40 圖 4 初次使用FGAs的歷年百分比 41 圖 5 初次使用SGAs的歷年百分比 42 圖 6初次用藥方式與後續住院之關係 43 圖 7初次用藥方式與後續平均住院次數之關係 44 圖 8初次用藥方式與後續平均住院天數之關係 45 圖 9後續用藥方式與後續住院之關係 46 圖 10後續用藥方式與後續住平均院次數之關係 47 圖 11後續用藥方式與後續平均住院天數之關係 48 表目錄 表 1文獻回顧 49 表 2患者基本特性分析 52 表 3患者性別在各年齡間的分布 54 表 4診斷後距離初次用藥的期間 55 表 5使用抗精神病藥物患者之基本特性分析 56 表 6年齡與第一筆開方的分布 58 表 7年齡與單一開方及合併用藥的分布 59 表 8不同醫院層級年齡與藥品的分析 60 表 9患者初次使用FGAs的人數與百分比 61 表 10患者初次使用SGAs的人數與百分比 62 表 11不同性別初次使用抗精神病藥物的種類 63 表 12不同年齡層初次使用FGAs的種類 64 表 13不同年齡層初次使用SGAs的種類 65 表 14初次常用的抗精神病藥物與患者共病症及共用藥物分析 66 表 15醫院層級與初次開方之分布 68 表 16醫院層級與單一開方及合併用藥之分布 69 表 17不同醫院層級對於抗精神病藥物常用的初次開方 70 表 18患者初次使用的劑型比較 71 表 19患者特性歷年之分析 72 表 20使用抗精神病藥物的患者歷年分析 74 表 21初筆開方為SGAs相對於FGAs與患者背景特性之分析 77 表 22初筆開方為FGAs合併SGAs相對於FGAs與患者背景特性之分析 78 表 23後續用藥為轉換用藥相對於單一成分與患者背景特性之分析 79 表 24後續用藥為合併用藥相對於單一成分與患者背景特性之分析 80 表 25排除診斷前已使用藥品條件之患者年齡與歷年分布 81 表 26納入診斷前已使用藥品條件之患者年齡與歷年分布 81 附錄目錄 附錄 1台灣抗精神疾病藥物種類 82 附錄 2藥品健保開始給付年代 83 附錄 3長效注射劑型藥品 84 附錄 4藥品品項 85 附錄 5共病症及其對應的ICD-9-CM 88 附錄 6 Multivariate logistic regression變項之勝算比 89 附錄 7 FGAs與SGAs之比較 90 附錄 8第一代精神病藥物副作用強度之比較 91 附錄 9第二代精神病藥物副作用強度之比較 92 附錄 10抗精神病藥物適應症 93 | |
dc.language.iso | zh-TW | |
dc.title | 新治療的思覺失調症病人抗精神藥物使用的趨勢 | zh_TW |
dc.title | Trends in Antipsychotic Use of Newly Treated Schizophrenia Patients | en |
dc.type | Thesis | |
dc.date.schoolyear | 106-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 吳其炘,丁德天,蕭斐元 | |
dc.subject.keyword | 思覺失調症,抗精神病藥物,使用,趨勢,形式, | zh_TW |
dc.subject.keyword | schizophrenia,antipsychotics,utilization,trend,pattern, | en |
dc.relation.page | 102 | |
dc.identifier.doi | 10.6342/NTU201801860 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2018-07-26 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 藥學研究所 | zh_TW |
顯示於系所單位: | 藥學系 |
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