정신병적 장애로 첫 내원한 환자들의 임상 특징과 투약 순응도 및 의료 이용 추이: 예비 연구
Clinical Characteristics, Drug Adherence to Antipsychotics and Medical Use Trends in Patients First Diagnosed with Psychotic Disorder: A Preliminary Study
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Objectives: In this preliminary study, we investigated the clinical characteristics of patients who were first diagnosed with psychotic disorder and explored the impact of the adherence to antipsychotics on long-term medical use. Methods: All national health insurance claims related to psychotic disorders including gender, age, income, and drug compliance, from January 1, 2008 to December 31, 2015, were examined. With trend test using Medication Possession Ratio (MPR), we compared the medical use between the compliant group (MRP≥0.8) and the comparative non-compliant group (0.2≤MPR＜0.8). Results: Among 28,095 participants in total, 16,239 patients (57.8%) were diagnosed as schizophrenia; the 30s were the most common (n=7,151, 25.5%). Drug compliance was generally low regardless of the diagnosis and was the lowest among 20s with the 4060% range of income. The compliant group showed lower psychiatric and medical use than the comparative group in the following years (p＜0.0001). Conclusion: These findings suggest that patients in the 20s and 30s with the 40-60% range of income, who are diagnosed with schizophrenia at the first psychiatric visit, may need more clinical and political attention. The results also emphasize the importance of initial drug adherence to antipsychotics in reducing long-term psychiatric costs.
Abstract
Objectives: In this preliminary study, we investigated the clinical characteristics of patients who were first diagnosed with psychotic disorder and explored the impact of the adherence to antipsychotics on long-term medical use. Methods: All national health insurance claims related to psychotic disorders including gender, age, income, and drug compliance, from January 1, 2008 to December 31, 2015, were examined. With trend test using Medication Possession Ratio (MPR), we compared the medical use between the compliant group (MRP≥0.8) and the comparative non-compliant group (0.2≤MPR＜0.8). Results: Among 28,095 participants in total, 16,239 patients (57.8%) were diagnosed as schizophrenia; the 30s were the most common (n=7,151, 25.5%). Drug compliance was generally low regardless of the diagnosis and was the lowest among 20s with the 4060% range of income. The compliant group showed lower psychiatric and medical use than the comparative group in the following years (p＜0.0001). Conclusion: These findings suggest that patients in the 20s and 30s with the 40-60% range of income, who are diagnosed with schizophrenia at the first psychiatric visit, may need more clinical and political attention. The results also emphasize the importance of initial drug adherence to antipsychotics in reducing long-term psychiatric costs.
참고문헌 (41)
- American Psychiatric Association, "Diagnostic and statistical manual of mental disorders", Hakjisa, 93~94 (2013)
- National Collaborating Centre for Mental Health, "National Institute for Health and Clinical Excellence: Guidance. Psychosis and Schizophrenia in Adults: Treatment and Management: Updated Edition 2014", National Institute for Health and Care Excellence, 14~15 (2014)
- Keshavan MS, "Schizophrenia, “Just the Facts” 6. Moving ahead with the schizophrenia concept: from the elephant to the mouse", Schizophr Res, 127, pp.3~13 (2011)
- Lehman AF, "Practice guideline for the treatment of patients with schizophrenia", Am J Psychiatry, pp.161~ (2004)
- Kreyenbuhl J, "The schizophrenia patient outcomes research team (PORT): updated treatment recommendations. 2009", Schizophr Bull, 36, pp.94~103 (2010)
- Hasan A, "World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for biological treatment of schizophrenia, Part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance", World J Bio Psychiatry, 13, pp.318~378 (2012)
- Häfner H, "Risk and protective factors in schizophrenia", pp.207~228 (2002), Heidelberg
- Klosterkötter J, "Diagnosing schizophrenia in the initial prodromal phase", Arch Gen Psychiatry, 58, pp.158~164 (2001)
- Falkenberg I, "Why are help-seeking subjects at ultra-high risk for psychosis help-seeking?", Psychiatry Res, 228, pp.808~815 (2015)
- Simon GE, "Care pathways prior to first diagnosis of psychotic disorder in adolescents and young adults", Am J Psychiatry, 175, pp.434~442 (2018)
- Marshall M, "Early intervention for psychosis", Schizophr Bull, 37, pp.1111~1114 (2011)
- 김혜금, "정신과 질환에서의 임상 병기 및 조기 개입", 생물치료정신의학, 22(2), pp.67~83 (2016), 대한생물치료정신의학회
- McGorry PD, "Early intervention in psychosis:concepts, evidence and future directions", World Psychiatry, 7, pp.148~156 (2008)
- Mihalopoulos C, "Is early intervention in psychosis cost-effective over the long term?", Schizophr Bull, 35, pp.909~918 (2009)
- McGorry PD, "Intervention in individuals at ultra-high risk for psychosis:a review and future directions", J Clin Psychiatry, 70, pp.1206~1212 (2009)
- Morrison AP, "Cognitive therapy for the prevention of psychosis in people at ultra-high risk", Br J Psychiatry, 185, pp.291~297 (2004)
- 박종익, "정신질환에 대한 사회적 편견", 신경정신의학, 55(4), pp.299~309 (2016), 대한신경정신의학회[DOI]
- 김재훈, "정신장애 유형에 따른 편견과 차별 - 사례를 활용한 대학생 조사 결과-", 정신건강과 사회복지, (37), pp.35~64 (2011), 한국정신건강사회복지학회
- Kane JM, "Psychopharmacologic treatment of schizophrenia", Schizophr Bull, 19, pp.287~302 (1993)
- Dixon LB, "Conventional antipsychotic medications for schizophrenia", Schizophr Bull, 21, pp.567~577 (1995)
- Leucht S, "Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis", Lancet, 379, pp.2063~2071 (2012)
- Tiihonen J, "Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study", BMJ, 333, pp.224~ (2006)
- Geddes J, "Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis", BMJ, 321, pp.1371~1376 (2000)
- Weiden PJ, "Cost of relapse in schizophrenia", Schizophr Bull, 21, pp.419~429 (1995)
- Valenstein M, "Pharmacy data identify poorly adherent patients with schizophrenia at increased risk for admission", Med Care, 40, pp.630~639 (2002)
- Terkelsen KG, "Measuring the costs of schizophrenia:implications for the post-institutional era in the US", Pharmacoeconomics, 8, pp.199~222 (1995)
- Bellack AS, "The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness", J Clin Psychiatry, 70, pp.1~48 (2009)
- Morken G, "Non-adherence to antipsychotic medication, relapse and rehospitalisation in recent-onset schizophrenia", BMC Psychiatry, 8, pp.32~ (2008)
- Correll CU, "Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents", JAMA, 302, pp.1765~1773 (2009)
- Newcomer JW, "Second-generation (atypical) antipsychotics and metabolic effects", CNS Drugs, 19, pp.1~93 (2005)
- Szmulewicz AG, "Long-term antipsychotic use and major cardiovascular events: a retrospective cohort study", J Clin Psychiatry, 78, pp.e905~e912 (2017)
- Newcomer JW, "Severe mental illness and risk of cardiovascular disease", JAMA, 298, pp.1794~1796 (2007)
- Casey DE, "Metabolic issues and cardiovascular disease in patients with psychiatric disorders", Am J Med, 118, pp.15~22 (2005)
- Sajatovica M, "Measurement of psychiatric treatment adherence", J Psychosom Res, 69, pp.591~599 (2010)
- Ascher-Svanum H, "Medication adherence and long-term functional outcomes in the treatment of schizophrenia in usual care", J Clin Psychiatry, 67, pp.453~460 (2006)
- Valenstein M, "Poor antipsychotic adherence among patients with schizophrenia: medication and patient factors", Schizophr Bull, 30, pp.255~264 (2004)
- Krousel-Wood M, "New medication adherence scale versus pharmacy fill rates in hypertensive seniors", Am J Manag Care, 15, pp.59~66 (2009)
- Huybrechts KF, "Assessment of compliance with osteoporosis treatment and its consequences in a managed care population", Bone, 38, pp.922~928 (2006)
- Andrade SE, "Methods for evaluation of medication adherence and persistence using automated databases", Pharmacoepidemiol Drug Saf, 15, pp.565~574 (2006)
- Häfner H, "The influence of age and sex on the onset and early course of schizophrenia", Br J Psychiatry, 162, pp.80~86 (1993)
- Kendler KS, "Demography of paranoid psychosis (delusional disorder)", Arch Gen Psychiatry, 39, pp.890~902 (1982)