Antipsychotic medications are the first-line pharmacological intervention for severe mental illnesses (SMI) such as schizophrenia and other psychoses, while also being used to relieve distress and treat neuropsychiatric symptoms in dementia. Our aim was to examine the factors relating to antipsychotic prescribing in general practices across England and how cost changes in recent years have impacted on antipsychotic prescribing. The study examined over time the prescribing volume and prices paid for antipsychotic medication by agent in primary care. Monthly prescribing in primary care was consolidated over 5 years (2013–2018) and DDD amount from WHO/ATC for each agent was used to convert the amount to total DDD/practice. The defined Daily Dose (DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. We included 5750 general practices with practice population > 3000 and with > 30 people on their SMI register. In 2018/19 there were 10,360,865 prescriptions containing 136 million DDD with costs of £110 million at an average cost of £0.81/DDD issued in primary care. In 2017/18 there was a sharp increase in overall prices and they had not reduced to expected levels by the end of the 2018/19 evaluation year. There was a gradual increase in antipsychotic prescribing over 2013–2019 which was not perturbed by the increase in drug price in 2017/18. The strongest positive relation to increased prescribing of antipsychotics came from higher social disadvantage, higher population density (urban), and comorbidities e.g. chronic obstructive pulmonary disease (COPD). Higher % younger and % older populations, northerliness and non-white (Black and Minority Ethnic(BAME)) ethnicity were all independently associated with less antipsychotic prescribing. Higher DDD/general practice population was linked with higher proportion(%) injectable, higher %liquid, higher doses/prescription and higher %zuclopenthixol depot. Less DDD/population was linked with general practices using higher % risperidone and higher spending/dose of antipsychotic. The levels of antipsychotic prescribing at general practice level are driven by social factors/comorbidities. We found a link between depot prescriptions with higher antipsychotic DDD and risperidone prescriptions with lower antipsychotic DDD. It is important that all prescribers are aware of these drivers / links.

中文翻译：

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在一般实践水平上每个人群开出的抗精神病药物的数量，当地人口统计学因素与药物选择之间的联系

抗精神病药是针对严重精神疾病（SMI）（例如精神分裂症和其他精神病）的一线药理干预措施，同时也用于缓解痴呆症和治疗痴呆症的神经精神症状。我们的目的是研究整个英格兰的常规治疗中与抗精神病药物处方有关的因素，以及近年来的成本变化如何对抗精神病药物处方产生影响。该研究随着时间的流逝检查了初级保健机构为抗精神病药物支付的处方量和价格。在5年（2013-2018年）中合并了初级保健的每月处方，并使用了WHO / ATC对每个代理人的DDD金额将其转换为DDD /做法的总和。定义的每日剂量（DDD是成人主要指征的药物每天假定的平均维持剂量）。我们在他们的SMI注册中包括5750个常规实践，其中实践人口> 3000，并且> 30人。在2018/19年度，初级保健部门开出了10,360,865张处方，包含1.36亿DDD，费用为1.1亿英镑，平均费用为0.81 / DDD。在2017/18年度，整体价格急剧上涨，到2018/19评估年度末，价格并未降至预期水平。在2013-2019年期间，抗精神病药物的处方逐渐增加，但不受2017/18年度药品价格上涨的干扰。与增加抗精神病药处方的最密切的积极关系来自较高的社会劣势，较高的人口密度（城市）和合并症，例如慢性阻塞性肺疾病（COPD）。年轻人口和老年人口的百分比更高，北方人和非白人（黑人和少数族裔（BAME））种族都与较少的抗精神病药物处方相关。较高的DDD /一般执业人群与较高的可注射比例（％），较高的液体百分比，较高的剂量/处方和较高的zuclopenthixol储库有关。较少的DDD /人群与使用较高的利培酮和较高的抗精神病药剂量/剂量的一般做法相关联。一般实践水平的抗精神病药物处方水平受社会因素/合并症的影响。我们发现抗精神病药DDD较高的储库处方与抗精神病药DDD较低的利培酮处方之间存在联系。所有处方者都必须意识到这些驱动程序/链接，这一点很重要。较高的DDD /一般实践人群与较高的可注射比例（％），较高的液体百分比，较高的剂量/处方和较高的zuopenopenxixol储库有关。较少的DDD /人群与使用较高的利培酮和较高的抗精神病药剂量/剂量的一般做法相关联。一般实践水平的抗精神病药物处方水平受社会因素/合并症的影响。我们发现抗精神病药DDD较高的储库处方与抗精神病药DDD较低的利培酮处方之间存在联系。所有处方者都必须意识到这些驱动程序/链接，这一点很重要。较高的DDD /一般实践人群与较高的可注射比例（％），较高的液体百分比，较高的剂量/处方和较高的zuclopenthixol储库有关。较少的DDD /人群与使用较高的利培酮和较高的抗精神病药剂量/剂量的一般做法相关联。一般实践水平的抗精神病药物处方水平受社会因素/合并症的影响。我们发现抗精神病药DDD较高的储库处方与抗精神病药DDD较低的利培酮处方之间存在联系。所有处方者都必须意识到这些驱动程序/链接，这一点很重要。较少的DDD /人群与使用较高的利培酮百分比和较高的抗精神病药剂量/剂量的一般做法相关联。一般实践水平的抗精神病药物处方水平受社会因素/合并症的影响。我们发现抗精神病药DDD较高的储库处方与抗精神病药DDD较低的利培酮处方之间存在联系。所有处方者都必须意识到这些驱动程序/链接，这一点很重要。较少的DDD /人群与使用较高的利培酮和较高的抗精神病药剂量/剂量的一般做法相关联。一般实践水平的抗精神病药物处方水平受社会因素/合并症的影响。我们发现抗精神病药DDD较高的储库处方与抗精神病药DDD较低的利培酮处方之间存在联系。所有处方者都必须意识到这些驱动程序/链接，这一点很重要。