Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Tifratene, Karim; Manera, Valéria; Fabre, Roxane; Gros, Auriane; Thümmler, Susanne; Pradier, Christian; Robert, Philippe; David, Renaud

doi:10.1186/s13195-017-0256-8

Cited by 15 publications

(14 citation statements)

References 47 publications

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“…We did not find any association between age and AP prescription while previous studies showed that overall antipsychotic use is significantly lower for older patients 16,35,36…”

Section: Discussioncontrasting

confidence: 94%

“…Some studies found that women were more frequently prescribed APs than men 29–31. However, consistent with findings from some other studies,16,32,33 in our study men were more likely than women to be prescribed with APs. A recent review by Trenaman et al34 observed that men and women tend to use more antipsychotics dependent on their living environment, women in the community and men in long-term care facilities.…”

Section: Discussionsupporting

confidence: 92%

“…There is sound evidence that APs are widely used for the treatment of BPSD in older people 5,13. Following the warnings on the risk associated with AP use issued since 2004 by international and national regulatory agencies, their use has decreased although prescription rates largely differ across countries and remain high, especially among institutionalized dementia patients 14–16. In Italy, despite the safety warnings, no decrease of AP use in persons with dementia has been observed between 2009 and 2012 14.…”

Section: Introductionmentioning

confidence: 99%

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<p>Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy</p>

Bargagli¹,

Cascini²,

Agabiti³

et al. 2019

CIA

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IntroductionDespite recommendations from associations of geriatric and psychiatry societies and warnings from drug agencies, antipsychotic (AP) drugs are frequently used to control behavioral and psychological symptoms of dementia. APs are associated with a range of potential adverse events, including increased risk of cerebrovascular events and mortality. Evidence suggests limited efficacy of APs for aggression and psychosis. Our objectives were to investigate patterns and predictors for prescription of APs among older adults with dementia residing in a large region of central Italy, and to identify patient characteristics related to typical or atypical APs prescribing.MethodsThis is a retrospective population-based cohort study using data from regional health information systems (HIS). We included dementia patients aged ≥65 years residing in the Lazio region. The exposure was defined as new use vs non-use of APs. Dementia patients with incident use of APs during 2015 were followed-up from the date of first prescription to the earliest among discontinuation of use, death, or end of study (December 31, 2016).ResultsWe enrolled 24,735 dementia patients, 1727 (6.7%) new users and 23,008 non-users of APs. Forty-four percent of AP users were treated for more than 3 months, and among these about 60% received APs continuously for at least 12 months. Individuals using antidepressant or anti-dementia drugs had higher odds of being prescribed with APs (OR: 1.67 and OR: 1.86, respectively). Patients exposed to polypharmacy were less likely to receive APs (OR: 0.82). Cardiovascular risk factors and comorbidities were not associated with APs use. Low socio-economic position was associated with lower odds of atypical AP prescribing (OR: 0.57).ConclusionThe study showed that a not negligible proportion of patients had a period of AP use longer than recommended by guidelines. We identified socio-demographic and clinical factors associated with first use of APs, providing insight into prescribing practices in a community setting and useful information to address areas of potential inappropriateness.

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“…We did not find any association between age and AP prescription while previous studies showed that overall antipsychotic use is significantly lower for older patients 16,35,36…”

Section: Discussioncontrasting

confidence: 94%

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy</p>

Bargagli¹,

Cascini²,

Agabiti³

et al. 2019

CIA

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“…Antipsychotic medications are the first-line pharmacological intervention for severe mental illnesses (SMI) such as schizophrenia [ 1 , 2 ] and other psychoses, while also being used to relieve distress and to treat neuropsychiatric symptoms in dementia [ 3 ]. Oral antipsychotic medication prescribed in primary care is one of the main sources of support to people with a history of psychosis.…”

Section: Introductionmentioning

confidence: 99%

Links between the amount of antipsychotic medication prescribed per population at general practice level, local demographic factors and medication selection

et al. 2020

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Background 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. Methods 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. Results 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. Conclusions 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.

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“…Antipsychotic medications are the first-line pharmacological intervention for severe mental illnesses (SMI) such as schizophrenia (1) and other psychoses, while also being used to relieve distress and to treat neuropsychiatric symptoms in dementia (2). Oral antipsychotic medication prescribed in primary care is one of the main sources of support to people with a history of psychosis.…”

Section: Introductionmentioning

confidence: 99%

Links between the amount of antipsychotic medication prescribed per population at general practice level, local demographic factors and medication selection

Heald

Stedman

Farman

et al. 2020

Preprint

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BACKGROUND 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. Since 2014 many antipsychotic agents have moved to generic provision. In 2017_18 supplies of certain generic agents were affected by substantial price increases. Our aim was to examine factors relating to antipsychotic prescribing in general practices across England and how cost changes in recent years have impacted. METHODS The study examined over time the prescribing volume/prices paid for antipsychotic medication by agent in primary care. The NHS in England/Wales publishes each month the prescribing in general practice by BNF code. This was aggregated for the year 2018_19 using Defined Daily doses (DDD). Cost of each agent year-on-year was determined. 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. RESULTS Description We included 5,750 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. Effect of price In 2017_18 there was a sharp increase in overall prices. There was a gradual increase in antipsychotic prescribing over 2013-2019 which was not perturbed by the drug price increase in 2017/18. Regression Demographic factors 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 (BME)) ethnicity were all independently associated with less antipsychotic prescribing. Prescribing Factors Higher DDD/general practice population was linked with higher %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. CONCLUSIONS Levels of antipsychotic prescribing at general practice level are driven by social factors/comorbidities. We found a contrasting link between depot prescriptions with higher DDD and risperidone prescriptions with lower DDD.

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Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Cited by 15 publications

References 47 publications

<p>Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy</p>

<p>Determinants Of Antipsychotic Drugs Prescription Among Community-Living Older Adults With Dementia: A Population-Based Study Using Health Information Systems In The Lazio Region, Italy</p>

Links between the amount of antipsychotic medication prescribed per population at general practice level, local demographic factors and medication selection

Links between the amount of antipsychotic medication prescribed per population at general practice level, local demographic factors and medication selection

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