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

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.

Sleep problems in out-patient of primary care unit.

OBJECTIVE: The prevalence and factors associated with sleep problems among out-patients of the Family Medicine Department in Ramathibodi Hospital were evaluated and their management was assessed. MATERIAL AND METHOD: Descriptive study, out-patients in family medicine clinic (n = 512) were selected by stratified random sampling. Sleep problems during the previous month were assessed by using questionnaires. Excessive daytime sleepiness (EDS) was assessed by Epworth sleepiness scale. The medical records of 45 patients with habitual insomnia during the previous 6 months were retrieved to study its management. The data were analyzed by Chi-square, Odds ratio, 95% Confident Interval and binary logistic regression. RESULTS: Half of the subjects (50.4%) had chronic diseases. Age range was 20-78 years old and 69.9% were female. Insomnia distributed almost equally in all age groups. Approximately 57.9% and 19.5% of the subjects reported insomnia and sleepiness. One fourth of the participants (24.7%) had snored and this was more often in men than women (OR 1.7). Anxiety score, female, and perception of their illness and disease were strong factors associated with insomnia. Most of them (71.1%) did not consult their doctors despite having habitual insomnia. From medical records reviewed, only one fourth of them (28.9% and 26.7%) were recorded about the insomnia and the prescriptions. CONCLUSION: More than half of the out-patients in primary care had sleep problems, especially insomnia, and excessive daytime sleepiness, but few of them consulted their doctors. This problem should not be overlooked Psychological problems and anxiety with their illness were associated with insomnia. Therefore, exploring and understanding their problems are important issues to manage and render advice for their quality sleep.

Type 2 diabetic patient-centered care.

BACKGROUND: The prevalence of diabetes mellitus has increased worldwide including Thailand. Management of diabetes should be considered biological and psychosocial. Patient-centered care was applied in the present study. Patient-centered care is a process interaction between the clinician and the patient. It refers to the clinician's behavioral skill in the consultation. Patient-centered care customizes seeking and accepting the patient's ideas, seeking and giving recognition and encouragement, treatment recognition and decision making in response to the individual patient's perspective. OBJECTIVE: To evaluate the efficacy of patient-centered care on type 2 diabetes mellitus. Their fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), eating and exercise behavior, compliance, symptoms of diabetes as well as satisfaction were compared before and after the intervention. MATERIAL AND METHOD: The quasi-experimental design (controlled before and after intervention) was conducted among 78 patients with type 2 diabetes mellitus who regularly attended the outpatient clinic, Family Medicine Department, whose FPG was more than 150 mg/dL, non pregnant, could communicate well in Thai and had no other complications. The patients were required to follow on Wednesday morning every 6-10 weeks for one year. A group of 6-10 patients was appointed in each visit. The six interconnecting components of patient-centered care were applied. (1) The patients and the researchers were introduced to each other to enhance the relationship between the patients, doctors and researchers. (2) In each visit, by using a group process and individual approach, the authors explored, assessed and analyzed both the disease, the illness (patient's ideas, feelings, expectations and functions), drug compliance, eating and exercise behavior. (3) The patient's life, family history, psychological and social behaviors were emphasized. (4) Setting the goals of FPG level that is achievable and agreeable to both the physician and patients. (5) Each patient was required to attend both nutrition and exercise education workshops. (6) Self care and self records on food items as well as nutrition and exercise practice were emphasized in order to incorporate them into their lifestyle. RESULTS: There were 53 females (67.9%) and 25 males (32.1%). Average age was 57.2 years. Diabetes duration was 6.75 +/- 5.45 years. Mean FPG of overall subjects decreased 43.07 +/- 76.32 mg/dL. About 16.44% had FPG below 126 mg/dL. 55.13% retained the same hypoglycemic medications, 10.5% had decreased dosage. Amongst 33 subjects (42.3%) who completed the program, FPG decreased 73.58 +/- 70.99 mg/dL (p < 0. 000). HbA1c decreased 0. 92 +/- 1.41% (p = 0. 001). Eating behavior (p < 0.000) and exercise behavior (p < 0.05) were better. Symptoms of diabetes were improved. Patient's satisfaction indicated that they had a better understanding of the disease and illness. They were eager to share their experiences with others and able to develop a relationship with the health care team. Amongst 45 patients (57.7%) who partially followed the program, FPG decreased 39.55 +/- 68.54 mg/dL (p = 0. 001). CONCLUSION: Glycemic control of type 2 diabetes subjects was improved by patient-centered care. Eating and exercise behaviors, compliance, symptoms of diabetes were better. This pilot study showed that the health status was improved not only by the biological indicators but also by behavior. The present study provided a beneficial impact on improving the health status of type 2 diabetes.