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首页> 外文期刊>The journal of clinical psychiatry >The impact of the clinical antipsychotic trials of intervention effectiveness (CATIE) on prescribing practices: An analysis of data from a large midwestern state
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The impact of the clinical antipsychotic trials of intervention effectiveness (CATIE) on prescribing practices: An analysis of data from a large midwestern state

机译：干预效果的临床抗精神病药物试验（CATIE）对处方操作的影响：来自中西部大型州的数据分析

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Background: The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) was a series of effectiveness trials. The results of these trials began publication in September 2005. Among other findings, these studies were interpreted to suggest that (1) second-generation antipsychotics might have fewer advantages over first-generation antipsychotics than had been generally thought; (2) among the agents assessed, olanzapine had the best efficacy outcome; and (3) after treatment failure with a second-generation antipsychotic, the most efficacious second-line medication is clozapine. To examine the actual impact on practice of these publications, we looked at change in physician prescribing behavior based on these 3 conclusions before and after publication of CATIE. Method: Rates of antipsychotic medication prescriptions to 51,459 patients with an ICD-9 code of 295 for schizophrenia were extracted from a Missouri Medicaid claims database. χ 2 Tests were used to compare the rates of prescribing antipsychotic medications before and after each of 3 key CATIE publications (time 1 was September 2005, time 2 was December 2006, and time 3 was April 2006). Results: At all time points, we demonstrated a decrease in prescriptions by all prescribers for olanzapine (P .0001). One year after time 1, we found an increase in prescriptions by all prescribers for aripiprazole (P .0001). No statistically significant increases in clozapine prescribing were observed. Also, a small but statistically significant increase was seen in prescriptions of perphenazine (P .02 at time 3). However, this increase occurred only for prescriptions written by psychiatrists and not other prescribers. Conclusions: We found some evidence in our sample that the publication of the results from CATIE had a small but statistically significant effect on prescribing habits of psychiatrists but not other physicians in our sample population. However, larger changes occurred in prescribing behavior that were largely unrelated to the CATIE trial. We propose a hypothesis to explain the direction of observed changes.
机译：背景：干预效果的临床抗精神病药物试验（CATIE）是一系列有效性试验。这些试验的结果于2005年9月开始发表。在其他发现中，这些研究被解释为表明：（1）第二代抗精神病药比第一代抗精神病药的优势可能比通常认为的要少; （2）在评估的药物中，奥氮平的疗效最佳; （3）第二代抗精神病药治疗失败后，最有效的第二线药物是氯氮平。为了检查这些出版物对实践的实际影响，我们基于CATIE出版前后这3个结论，研究了医师开处方行为的变化。方法：从密苏里州医疗补助索赔数据库中提取了51,459例ICD-9精神分裂症患者的抗精神病药物处方率，为295。 χ2测试用于比较3种主要CATIE出版物中的每一种前后的抗精神病药物处方率（时间1是2005年9月，时间2是2006年12月，时间3是2006年4月）。结果：在所有时间点上，我们均证明所有处方者的奥氮平处方量均有所减少（P <.0001）。从时间1开始的一年后，我们发现所有处方者对阿立哌唑的处方都有所增加（P <.0001）。没有观察到氯氮平处方的统计学显着增加。此外，奋乃静的处方中有少量但统计学上显着的增加（在时间3时P <.02）。但是，这种增加仅发生在由精神科医生而不是其他开处方者开出的处方上。结论：我们在样本中发现了一些证据，表明CATIE的结果公布对样本人群中精神科医生的处方习惯影响很小，但在统计学上具有显着意义，而对其他医师的处方习惯没有影响。但是，处方行为发生了较大的变化，而这些变化在很大程度上与CATIE试验无关。我们提出一个假设来解释观察到的变化的方向。

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