Consumption of psychotropic medications in primary healthcare in Ribeirão Preto, São Paulo State, Brazil

The consumption of psychotropic drugs is considered a public health problem, due to the potential for addiction and the occurrence of adverse events. In this context, the current study aimed to characterize the consumption of psychotropic medications dispensed in primary healthcare units in Ribeirão Preto, São Paulo State, Brazil. This ecological study consulted the Hygia database from 2008 to 2012. The following variables were extracted: psychotropic drugs dispensed, amount dispensed per year, and patients’ sex and age bracket. For each psychotropic drug, we calculated the defined daily dose per 1,000 inhabitants/day (DDD/1,000PD), defined daily dose per 1,000 inhabitants/day considering 75% of the population (DDD75%/1,000PD) who withdrew medicines through the Brazilian Unified National Health System (SUS), and the prescribed daily dose (PDD). The study compared the population growth rate to the growth in the medicines’ consumption. A total of 1,577,241 patients were identified who withdrew medications during the study period, of whom 287,373 (18.2%) used at least one drug subject to special control. There was an increase in the total consumption of psychotropic drugs (DDD/1,000PD), but comparison to the population growth rate showed that only sertraline (p = 0.021), risperidone (p = 0.034), and clonazepam (p = 0.043) presented higher growth rates. The PDD for seven drugs were higher than the World Health Organization (WHO) DDD. Identifying discrepancies between DDD and PDD can be useful as a strategy for screening patients eligible for pharmaceutical care, since they can contribute to the prevention of morbidity and mortality related to medications.

精神药物使用因存在成瘾风险及不良事件发生可能，被视为一项公共卫生问题。在此背景下，本研究旨在对巴西圣保罗州里贝朗普雷图市基层医疗机构配发的精神药物使用情况开展特征分析。本项生态学研究调取了2008年至2012年的Hygia数据库资料，提取的变量包括：配发精神药物的种类、年配发量，以及患者的性别与年龄分层。针对每种精神药物，本研究计算了每千居民日限定日剂量（defined daily dose per 1,000 inhabitants/day, DDD/1,000PD）、以通过巴西统一国家卫生系统（Sistema Único de Saúde, SUS）取药人群中75%的人口为基数的每千居民日限定日剂量（DDD75%/1,000PD），以及处方日剂量（prescribed daily dose, PDD）。本研究将人口增长率与药物使用增长率进行了对比分析。研究期间共纳入1577241名取药患者，其中287373名（18.2%）至少使用过1种受特殊管制的药物。精神药物总使用量（DDD/1,000PD）呈上升趋势，但与人口增长率对比后发现，仅舍曲林（sertraline, p=0.021）、利培酮（risperidone, p=0.034）及氯硝西泮（clonazepam, p=0.043）的增长率显著高于人口增速。7种药物的处方日剂量（PDD）高于世界卫生组织（World Health Organization, WHO）规定的限定日剂量（DDD）。识别限定日剂量与处方日剂量之间的差异，可作为筛选符合药学服务指征患者的有效策略，有助于预防与药物相关的发病率及死亡率。