Abstract
Antipsychotics are administered regularly for a prolonged period, which dose-dependently induces adverse events. Therefore, limits have been placed stepwise on antipsychotic prescriptions since the medical fee revision in 2012. However, there have been no detailed studies on the influence of the medical fee revision on prescription decision by physicians or the state of patients receiving drugs. Therefore, we assessed the influence of the medical fee revision on prescriptions for patients with schizophrenia. The subjects consisted of 35 outpatients with schizophrenia at the department of psychiatry of Hospital A in Gunma Prefecture. Antipsychotic prescriptions between March 2016 and September 2018 were analyzed. The mean age of the subjects was 49.2±11.0 years, and the percentages of males and females were 51.4% and 48.6%, respectively. The median (IQR) number of prescription antipsychotics was 4.5 (3.0-5.8) in March 2016, 4.0 (2.7-5.0) in May 2017, and 3.6 (3.0-4.0) in August 2018, exhibiting an annual decrease. The median (IQR) chlorpromazine equivalent dose (CP dose) was 454.6 (235.0-866.2) mg in March 2016 and 337.5 (200.0-611.5) mg in May 2017, demonstrating a significant decrease, but it was 350.0 (225.0-675.8) mg in August 2018. Following the medical fee revision, the number of prescribed drugs or components and the CP dose significantly decreased, suggesting a reduction in adverse effects, such as oversedation, associated with the patient QOL. Although there are limitations in the evaluation of patient treatment and studies on the QOL, periodical medical fee revisions aid in effective drug treatment for patients with schizophrenia without markedly infringing upon the physicians’ right to prescribe drugs.
