本研究的目的是評估精神分裂症患者在居家照護治療中，其用藥策略和治療效果之間的關係。
從全民健康保險研究資料庫取西元2004年至2009年ICD-9-CM診斷碼為295住院之個案為研究對象。研究對象為精神科出院後加入居家照護計畫且給予長效針劑，包含理思必妥長效針劑及傳統長效針劑（定義為長效針劑組）或口服抗精神病藥（定義為口服藥物組）的病人，來比較兩組用藥策略不同對再住院率的影響。
此研究的最終樣本數包含長效針劑組的810位個案及口服藥物組的945位個案。在控制病人、醫院特性及傾向分數後，本研究採取邏輯回歸統計方法，檢測在12個月的觀察期中，病患採取長效針劑治療對再住院風險的影響與使用口服抗精神病藥物有無差異。結果發現長效針劑組比口服藥物組在再住院風險的勝算比，校正前為0.80（信賴區間[CI]，0.65-0.98）。校正過後的勝算比下降至0.78（信賴區間[CI], 0.63-0.97）。校正傾向分數後，統計結果維持不變。顯示在居家照護治療中，使用長效針劑治療的病人，與使用口服抗精神病藥物相比可顯著降低精神科再住院率。
因此，在居家治療使用長效針劑，不論理思必妥長效針劑或傳統長效針劑，皆能降低病患再住院的機會與預防精神分裂症的復發，可為臨床及經濟帶來很大的助益。
We aimed at evaluating the relationship between medication and treatment effectiveness in a home-care setting among patients with schizophrenia.
Patients with schizophrenia hospitalized between 2004 and 2009 with a primary International Classification of Diseases, Ninth Revision, Clinical Modification code of 295, were identified from Psychiatric Inpatient Medical Claims Data released by the National Health Research Institute in Taiwan. Patients who joined the home-care program after discharge and were prescribed long-acting injections (LAI), including risperidone long-acting injections and conventional long-acting injections (the LAI group) or oral antipsychotic medications (the oral group) were included as study subjects.
The final sample for the study included 810 participants in the LAI group and 945 in the oral group. Logistic regression was performed to examine the independent effect of LAI medication on the risk for re-hospitalization within the 12-month observation window after controlling for patient and hospital characteristics and propensity score (PS) quintile adjustment. The unadjusted odds ratio (OR) for re-hospitalization risk was 0.80 (confidence interval [CI], 0.65-0.98) for the LAI group compared to the oral group. The adjusted OR was further reduced to 0.78 (CI, 0.63-0.97). Results remained unchanged when the PS quintiles were entered into the regression for further adjustment. In a home-care setting, patients treated with long-acting antipsychotic agents are at a significantly lower risk for psychiatric re-hospitalization than those treated with oral medication.
Consequently, LAI home-based treatment for the prevention of schizophrenia relapse may lead to substantial clinical and economic benefits.
