Psychotropic Drug Prescribing in the Family Medicine Out-Patient Clinic, Ramathibodi Hospital
Somjit Prueksaritanond MD, DTM&H, MSc*, Saisunee Tubtimtes BSc, MSc*, Taratip Pumkompol BSc, MSc*, Chakrit Sukying MD**
Affiliation : * Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ** Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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 of psychotropic 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 anti-
depressants (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 psycho-
logical 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 medica-
tions 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.
Keywords : Psychotropic drug, Prescribing, Primary care, Family medicine, Ambulatory care
