患有妇科疾病需要子宫切除术的妇女通常有共存的精神病诊断。子宫切除术前后抗抑郁药(AD)和抗焦虑药(AA)的分配模式发生变化可能是由于妇科症状的改善,如盆腔疼痛和异常出血,或者子宫切除术的情绪影响。不幸的是,目前尚未描述子宫切除术前后的这些分配模式。
对患有精神疾病的妇女在子宫内膜异位症和子宫肌瘤良性子宫切除术前后AD和AA药物随时间的分配模式进行建模;并根据这些模式表征具有各种分配行为的患者群。
■回顾性队列研究。
■这是一项使用MerativeMarkertScan®ResearchDatabases(AnnArbor,MI,美国)。纳入标准为育龄妇女(18-50岁),诊断至少一种情绪或焦虑症,和至少一种AD或AA药物的分配。我们测量了子宫切除术后12个月内AD/AA药物使用的每月依从性和持久性。基于组的轨迹建模(GBTM)用于识别研究期间每月AD/AA药物分配的轨迹组。多项逻辑回归用于识别与个体分配轨迹模式独立相关的因素。
■总共11,607名患者,在研究期间确定了6个分配轨迹组:持续高(27.0%),持续温和(21.9%),持续走低(17.9%),从低到高(10.0%),中低(9.8%),和低至中等(13.4%)。与持续高组比拟,年龄较小,没有情绪障碍史,和子宫肌瘤是低分配的临床预测因子。子宫切除术后3个月的停药率在持续低组高于88.6%,在持续低到中度组高于66.5%。
■这项研究表明,GBTM在围手术期确定了AD/AA药物分配的六个不同轨迹。轨迹模型可用于识别针对干预的特定分配模式。
生育年龄妇女良性子宫切除术后精神疾病抗抑郁药和抗焦虑药的分配模式:基于群体轨迹模型的结果妇科疾病妇女通常有共存的精神病诊断。抗抑郁药和抗焦虑药的分配方式的改变可能是由于妇科症状的改善或子宫切除术的情绪影响。然而,静态措施,例如承保天数的比例或药物持有率,可能无法充分预测有意义的分配模式。使用基于组的轨迹建模,确定了良性子宫切除术妇女围手术期的6种不同的药物分配模式,因此用于评估某些临床特征如何影响这些分配模式。这项研究得出的结论是,轨迹建模可能是调查先前存在精神疾病的女性配药方式的更合适方法。
UNASSIGNED: Women with gynecologic disorders requiring a hysterectomy often have co-existing psychiatric diagnoses. A change in the dispensing pattern of antidepressant (AD) and antianxiety (AA) medications around the time of hysterectomy may be due to improvement in gynecologic symptoms, such as pelvic pain and abnormal bleeding, or the emotional impact of the hysterectomy. Unfortunately, these dispensing patterns before and after hysterectomy are currently undescribed.
UNASSIGNED: To model the dispensing patterns of AD and AA medications over time among women with psychiatric disorders before and after benign hysterectomy for endometriosis and uterine fibroids; and to characterize clusters of patients with various dispensing behaviors based on these patterns.
UNASSIGNED: Retrospective cohort study.
UNASSIGNED: This is a study of women who underwent a benign hysterectomy using data from the Merative MarkertScan® Research Databases (Ann Arbor, MI, USA). Inclusion criteria were reproductive-aged women (18-50 years), diagnosis of at least one mood or anxiety disorder, and at least one dispensing of AD or AA medications. We measured monthly adherence and persistence of AD/AA medication use over 12 months after hysterectomy. Group-based-trajectory modeling (GBTM) was used to identify trajectory groups of monthly AD/AA medication dispensing over the study period. Multinomial logistic regression was used to identify factors independently associated with individual dispensing trajectory patterns.
UNASSIGNED: For a total of 11,607 patients, 6 dispensing trajectory groups were identified during the study period: continuously high (27.0%), continuously moderate (21.9%), continuously low (17.9%), low-to-high (10.0%), moderate-to-low (9.8%), and low-to-moderate (13.4%). Compared with the continuously high group, younger age, no history of a mood disorder, and uterine fibroids were clinical predictors of low dispensing. The discontinuation rate at 3 months after hysterectomy was higher at 88.6% in the continuously low group and at 66.5% in the continuously low-to-moderate group.
UNASSIGNED: This study demonstrates that GBTM identified six distinct trajectories of AD/AA medication dispensing in the perioperative period. Trajectory models could be used to identify specific dispensing patterns for targeting interventions.
Dispensing patterns of antidepressant and antianxiety medications for psychiatric disorders after benign hysterectomy in reproductive-aged women: Results from the group-based trajectory modelingWomen with gynecologic disorders often have coexisting psychiatric diagnoses. A change in the dispensing pattern of antidepressant and antianxiety medications may be due to improvement in gynecologic symptoms or the emotional impact of the hysterectomy. However, static measures, such as the proportion of days covered or medication possession ratio, may not adequately predict meaningful dispensing patterns. Using the group-based trajectory modeling, 6 distinct patterns of medication dispensing over the perioperative periods of women with benign hysterectomy are identified and therefore used to assess how certain clinical characteristics influence these dispensing patterns. This study concludes that trajectory modeling may be a more appropriate approach to investigating dispensing patterns among women with preexisting psychiatric conditions.