Psychotropic drug prescribing in the family medicine out-patient clinic, Ramathibodi Hospital

Abstract

Background: Primary care physicians are playing an increasing role in providing mental health care. Psychotropic drugs prescription may be used evaluate primary care physicians in treating and caring for mental disorders.

Objective: Evaluate the prevalence, pattern, and rational of psychotropic drugs prescribing by primary care physicians in a tertiary care university hospital.

Material and method: Four thousand four hundred ninety nine records of subjects aged 15 years old and older who received psychotropic drugs from a computer database between August 1, 2004 and January 31, 2005 were analyzed. Through systemic random sampling, rational drugs use from medical records of 575 patients was assessed.

Results: The rate ofpsychotropic drugs prescribing was 9.04%, which was found to increase with increasing age and female patients. Benzodiazepines were the most commonly prescribed (88.9%), followed by antidepressants (9.5%), and antipsychotics (1.1%). Lorazepam (34.7%), alprazolam (28.7%), and diazepam (19.2%) were the top three benzodiazepines prescribed. Polypharmacy was found at 13.4%. The drugs were prescribed for psychological conditions (74.8%; 51.7% by diagnosis and 23.1% by symptoms and/or signs), musculoskeletal disorder of the neck or spine (11.8%), chronic pain disorder (11.8%), and undocumented (1.6%). The psychological problems per se, physical problems per se, and the combination between psychological and physical problems were 21.6, 56.7, and 21.7% respectively. Insomnia, tension headache, and anxiety were the top three most common psychological diagnosis while hypertension, dyslipidemia, and low back pain were the top three most physical diagnosis. The long-term psychotropic drug use (2 months and above) comprised 25.9%. The follow up length ranged from less than 1 week to 24 weeks. The follow-up schedule was made in 73.9%. An actual return visit was 61.6%. Therefore, 12.3% was lost to follow up.

Conclusion: The present study illustrates the prevalence, pattern, and rational use of psychotropic medications in primary care of a tertiary university hospital. Intermediate-acting benzodiazepines were the most commonly prescribed. They were prescribed not only for mental but also for musculoskeletal and chronic pain disorders. A quarter of the patients received psychotropic drugs as well as long-term medications without diagnosis. Some patients were put on psychotropic drugs combination. To optimize patient outcomes, a diagnosis should be encouraged The long-term use and polypharmacy should be minimized. The quality and appropriateness of prescribed medication should be part of a future research project.