目的:关于心境障碍治疗指南对临床结局的影响的数据有限。这项研究的目的是调查处方者对2018年加拿大情绪和焦虑治疗网络(CANMAT)和国际双相情感障碍协会(ISBD)治疗指南建议的依从性对躁狂症住院患者再入院率的影响。
方法:金斯敦总医院因急性躁狂症入院的所有患者的回顾性队列研究,金斯顿,ON,2018年1月至2021年7月纳入本研究.从截至2021年12月31日的医疗记录中提取了有关指数入院和随后住院的患者变量和数据。治疗方案被列为一线,第二行,不合规,或者没有治疗。我们使用单变量研究了治疗方案与再入院风险之间的关系,多变量,和生存分析。
结果:我们确定了与165例患者相关的211例住院治疗。平均再入院时间为211.8天(标准差[SD]=247.1);30天再住院率为13.7%,再住院率为40.3%。与没有治疗相比,仅一线治疗与统计学上显著降低的30日再入院风险相关(比值比[OR]=0.209;95%CI,0.058~0.670).与没有治疗相比,一线治疗(OR=0.387;95%CI,0.173至0.848)和不合规治疗(OR=0.414;95%CI,0.174至0.982)降低了任何再入院的风险。关于生存分析,无治疗组的再入院时间较短(对数秩检验,p=0.014),与一线药物相比,再入院的风险增加(风险比=2.27;95%CI,1.30至3.96)。
结论:一线药物治疗与较低的30天再住院率和较长的再入院时间相关。医师坚持使用具有较高排名的疗效证据的治疗,安全,和耐受性可以改善双相情感障碍的结局.
There is limited data about the impact of mood disorders treatment
guidelines on clinical outcomes. The objective of this study was to investigate the impact of prescribers\' adherence to the 2018 Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) treatment
guidelines recommendations on the readmission rates of patients hospitalized for
mania.
A retrospective cohort of all individuals admitted due to acute
mania to Kingston General Hospital, Kingston, ON, from January 2018 to July 2021 was included in this study. Patient variables and data regarding index admission and subsequent hospitalizations were extracted from medical records up to December 31, 2021. Treatment regimens were classified as first-line, second-line, noncompliant, or no treatment. We explored the associations between treatment regimens and the risk of readmissions using univariate, multivariate, and survival analysis.
We identified 211 hospitalizations related to 165 patients. The mean time-to-readmission was 211.8 days (standard deviation [SD] = 247.1); the 30-day rehospitalization rate was 13.7%, and any rehospitalization rate was 40.3%. Compared to no treatment, only first-line treatments were associated with a statistically significant decreased risk of 30-day readmission (odds ratio [OR] = 0.209; 95% CI, 0.058 to 0.670). The risk of any readmission was reduced by first-line (OR = 0.387; 95% CI, 0.173 to 0.848) and noncompliant regimens (OR = 0.414; 95% CI, 0.174 to 0.982) compared to no treatment. On survival analysis, no treatment group was associated with shorter time-to-readmission (log-rank test, p = 0.014) and increased risk of readmission (hazard ratio = 2.27; 95% CI, 1.30 to 3.96) when compared to first-line medications.
Treatment with first-line medications was associated with lower 30-day rehospitalization rates and longer time-to-readmission. Physicians\' adherence to treatments with higher-ranked evidence for efficacy, safety, and tolerability may improve bipolar disorder outcomes.