title: Dilemma of prescribing aripiprazole under the Taiwan health insurance program: a descriptive study.
abstract: OBJECTIVE
  Refractory major depressive disorder (MDD) is a serious problem leading to a heavy economic burden. Antipsychotic augmentation treatment with aripiprazole and quetiapine is approved for MDD patients and can achieve a high remission rate. This study aimed to examine how psychiatrists in Taiwan choose medications and how that choice is influenced by health insurance payments and administrative policy.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  Eight questions about the choice of treatment strategy and atypical antipsychotics, and the reason to choose aripiprazole.
  
  
  METHODS
  We designed an augmentation strategy questionnaire for psychiatrists whose patients had a poor response to antidepressants, and handed it out during the annual meeting of the Taiwanese Society of Psychiatry in October 2012. It included eight questions addressing the choice of treatment strategy and atypical antipsychotics, and the reason whether or not to choose aripiprazole as the augmentation antipsychotic.
  
  
  RESULTS
  Choosing antipsychotic augmentation therapy or switching to other antidepressant strategies for MDD patients with an inadequate response to antidepressants was common with a similar probability (76.1% vs 76.4%). The most frequently used antipsychotics were aripiprazole and quetiapine, however a substantial number of psychiatrists chose olanzapine, risperidone, and sulpiride. The major reason for not choosing aripiprazole was cost (52.1%), followed by insurance official policy audit and deletion in the claims review system (30.1%).
  
  
  CONCLUSIONS
  The prescribing behavior of Taiwanese psychiatrists for augmentation antipsy-chotics is affected by health insurance policy.
authors: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan ; School of Medicine, National Defense Medical Center, Taipei, Taiwan.
authors: Yi-Chien
authors: YC
authors: Hsu
authors: School of Public Health, National Defense Medical Center, Taipei, Taiwan.
authors: Yu-Ching
authors: YC
authors: Chou
authors: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan ; School of Medicine, National Defense Medical Center, Taipei, Taiwan ; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan.
authors: Hsin-An
authors: HA
authors: Chang
authors: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan ; School of Medicine, National Defense Medical Center, Taipei, Taiwan ; Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, Taipei, Taiwan.
authors: Yu-Chen
authors: YC
authors: Kao
authors: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan ; School of Medicine, National Defense Medical Center, Taipei, Taiwan.
authors: San-Yuan
authors: SY
authors: Huang
authors: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan ; School of Medicine, National Defense Medical Center, Taipei, Taiwan ; Student Counseling Center, National Defense Medical Center, Taipei, Taiwan.
authors: Nian-Sheng
authors: NS
authors: Tzeng
keywords: National Health Insurance program; anti-psychotic augmentation; aripiprazole; major depressive disorder; prescribing behavior; psychiatrists
references: Chang Gung Med J. 2003 Feb;26(2):81-90
references: 12718384
references: Healthc Policy. 2007 Nov;3(2):e128-44
references: 19305773
references: Res Dev Disabil. 2014 Feb;35(2):364-72
references: 24333807
references: Arch Gen Psychiatry. 1996 Sep;53(9):842-8
references: 8792761
references: Biol Psychiatry. 2003 Apr 15;53(8):649-59
references: 12706951
references: Pharmacoeconomics. 2004;22(6):363-73
references: 15099122
references: JAMA. 1997 Jul 9;278(2):89-93
references: 9214512
references: Health Policy. 1997 Mar;39(3):225-39
references: 10165463
references: Dtsch Arztebl Int. 2009 Nov;106(46):751-5
references: 20019863
references: Arch Intern Med. 2006 Jan 9;166(1):57-63
references: 16401811
references: J Clin Psychiatry. 2007 Jun;68(6):843-53
references: 17592907
references: PLoS One. 2010 Aug 13;5(8):e12193
references: 20730093
references: Health Policy. 2004 Nov;70(2):185-95
references: 15364148
references: Cancer Epidemiol Biomarkers Prev. 2011 Mar;20(3):473-5
references: 21297039
references: Am J Manag Care. 2005 Jan;11 Spec No:SP14-20
references: 15700905
references: JAMA. 2002 Apr 10;287(14):1840-7
references: 11939870
references: Soc Psychiatry Psychiatr Epidemiol. 2013 Dec;48(12):1889-96
references: 23653092
references: J Clin Psychiatry. 2007 Jun;68(6):826-31
references: 17592905
references: Dialogues Clin Neurosci. 2004 Mar;6(1):53-60
references: 22034070
references: Health Aff (Millwood). 2003 May-Jun;22(3):77-88
references: 12757274
references: J Clin Psychopharmacol. 2008 Apr;28(2):156-65
references: 18344725
references: Psychiatr Q. 2012 Dec;83(4):521-9
references: 22528141
references: Drugs Aging. 2005;22(11):957-65
references: 16323972
references: BMJ. 2013 Jan 30;346:f264
references: 23372175
references: Eur Arch Psychiatry Clin Neurosci. 2003 Jun;253(3):132-9
references: 12904977
references: J Chin Med Assoc. 2013 Aug;76(8):432-7
references: 23786837
references: Depress Anxiety. 2005;22(2):68-76
references: 16094658
references: Int J Med Inform. 2006 Feb;75(2):173-81
references: 16125452