Increased use of second generation antipsychotic drugs in primary care: potential relevance for hospitalizations in schizophrenia patients.

Aim: To analyze the changes in the prescribing pattern of antipsychotic drugs in primary care in Extremadura (Spain) from 1990 to 2005, and the potential association with schizophrenia hospitalization rate.

Methods: Data from 1990-2005 about the prescribing of antipsychotic drugs was drawn from all community pharmacy sales figures reimbursed by the Health System of Extremadura. Drug consumption figures were expressed as the number of defined daily doses per 1,000 inhabitants and per day of treatment (DDD/1,000/day). The total number of annual hospital discharges with the diagnosis of schizophrenia according to DSM-IV criteria from all hospitals in Extremadura from 1 January 1995 to 31 December 2000 was also determined.

Results: The use of second-generation antipsychotic drugs (SGAs) increased from 0% in 1990-1993 to 78% in 2005. Olanzapine was the most used SGA from 1999-2005. During 1995-2000 the sales of SGAs increased to 50% from 10%. In the same period, the hospitalization rate in schizophrenia patients fell by an average of 12%, which was significantly associated with SGA use (R = -0.88; P = 0.02).

Discussion: The increase in SGAs paralleled the decreased rate of hospitalization in schizophrenia patients. However, the influence of other factors such as SGA use for disorders other than schizophrenia can not be ruled out. Moreover changes in the health-care system, such as the increase in primary mental health care and social rehabilitation programs, may also have a relevant influence.