Effects of medical service fee revision on reducing irrational psychotropic polypharmacy in Japan: an interrupted time-series analysis

Okada, Yusuke; Akazawa, Manabu

doi:10.1007/s00127-021-02147-0

Cited by 8 publications

(4 citation statements)

References 21 publications

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“…After the release of the expert consensus, both the prevalence of polypharmacy and PIM use decreased, especially the prevalence of PIM use. Regarding measures to reduce polypharmacy, studies have shown that unreasonable psychotropic drug polypharmacy in Japan can be reduced by revising the fee of medical services ( Hirano and Ii, 2019 ; Okada and Akazawa, 2022 ). In addition, there was a study on the application of electronic medicine reconciliation, which reduced the PIM use of elderly inpatients in tertiary hospitals after discharge and transfer to the community in Canada ( Welk et al, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of the expert consensus on polypharmacy and potentially inappropriate medication use in elderly lung cancer outpatients with multimorbidity: An interrupted time series analysis, 2016–2021

et al. 2022

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Objectives: Elderly lung cancer patients often have chronic diseases other than lung cancer. Therefore, this kind of population is often accompanied by polypharmacy. This situation and the resulting potentially inappropriate medication (PIM) use are an increasing global concern. In this context, the Chinese Association of Geriatric Research issued an expert consensus on the safety management of polypharmacy. However, the long- and short-term effects of the expert consensus on polypharmacy and PIM use are not clear.Methods: The study was conducted in Chengdu, a city in southwestern China, consisting of prescriptions for elderly lung cancer outpatients with multimorbidity (cancer with other diseases) from January 2016 to December 2021. The 2019 Beers criteria were used to evaluate PIM use, and interrupted time series analysis was used to evaluate the longitudinal effectiveness of expert consensus by measuring the prevalence of polypharmacy and PIM use. We used R software version 4.2.0 for data analysis.Results: A total of 7,238 elderly lung cancer outpatient prescriptions were included in the study. After the publication of the expert consensus, the level (β = -10.273, P < 0.001) of the prevalence of polypharmacy decreased, but the trend (β = 0.158, p = 0.855) of polypharmacy increased. The prevalence of PIM use decreased abruptly (β = -22.828, p < 0.001) after the intervention, but the long-term trend was still upward (β = 0.907, p = 0.916).Conclusion: The long-term effects of the publication of the expert consensus on the prevalence of polypharmacy and PIM use in hospitals in Chengdu were not optimal. Future research on interventions rationing polypharmacy and PIM use is needed.

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Section: Discussionmentioning

confidence: 99%

Impact of the expert consensus on polypharmacy and potentially inappropriate medication use in elderly lung cancer outpatients with multimorbidity: An interrupted time series analysis, 2016–2021

et al. 2022

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“…It is known that polypharmacy of psychotropic drugs causes negative drug effects, such as fall and impaired cognitive function [8][9][10]. In response to this issue, medical service fee revisions on multi-psychotropic drug prescriptions were implemented from 2012 to 2018 in Japan [11][12][13]. In Japan, "the Healthcare bill check and payment organization" checks claims data and pays medical costs directly to the medical facilities instead of the health insurers in the health insurance system.…”

Section: Introductionmentioning

confidence: 99%

“…In contrast, fees for the prescription and medication are not reduced when psychotropic medications are prescribed temporarily or when antipsychotics or antidepressants are unavoidably prescribed by a doctor with sufficient training in psychiatric clinical practice. As a result, the proportion of multi-psychotropic drug prescriptions decreased over the years in Japan [12,13]. Identification of patient traits or geographic areas linked to the multi-psychotropic drug prescriptions is crucial for furthering the improvement of multi-drug prescriptions.…”

Section: Introductionmentioning

confidence: 99%

Regional difference in multi-psychotropic drug prescription in Japan and its associated factors: an ecological study using national health insurance claims data

Okui

Nakashima

2023

Res Health Serv Reg

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Background In Japan, regulations preventing the prescriptions of various types of psychotropic drugs have become stricter in recent years. However, the areas where multi-psychotropic drug prescriptions are common and the geographic factors that contribute to the regional difference, have not been studied. In this study, we used data from all claims in Japan to examine regional differences in the prescription for multi-psychotropic drugs using an ecological study. Methods The National Database of Health Insurance Claims and Specific Health Checkups of Japan Open data in 2019 were used. The outcome was the number of prescriptions for four or more different types of anxiolytics and hypnotics as well as for three or more of the same kind of psychotropic drugs (any one of anxiolytics, hypnotics, antipsychotics, antidepressants) for outpatients in each area. Among the 335 secondary medical areas in Japan, the data on 331 areas were used in the analysis. The standardized claim ratio (SCR), an indicator of the number of this multi-psychotropic drug prescription, correcting for regional differences in distribution of population by age and sex, was calculated for each of the secondary medical areas. The spatial cluster detection technique was used to locate a cluster of high-SCR areas. Furthermore, factors associated with regional differences in the SCRs were examined by a spatial statistics model. Results North Japanese regions tend to have high SCRs, and 13 areas in Hokkaido were identified as the most likely cluster (cluster with the highest likelihood ratio) for multi-psychotropic drug prescription. Furthermore, a spatial regression analysis revealed that the proportion of people with lower educational levels, the total number of prescriptions per capita, and the number of physicians working in psychiatric departments per capita were statistically positively associated with the SCR for the prescription of multiple psychotropic drugs. Conclusions It was suggested that socioeconomic and medical characteristics of areas are related to the regional variation in the multi-psychotropic drug prescriptions, however, further research using individual-level data is required to confirm these results.

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“…Another study found that the 2018 amendment effectively reduced polypharmacy. However, the data for that study were drawn from a claims database maintained by a private company that does not include data from patients aged 75 years and above [ 18 ]. Therefore, information about recent long-term trends regarding nationwide polypharmacy in Japan that includes adults aged 75 years and above is lacking.…”

Section: Introductionmentioning

confidence: 99%

Nationwide Long-Term Evaluation of Polypharmacy Reduction Policies Focusing on Older Adults in Japan

Ishida

Suzuki

Nakata

2022

IJERPH

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Polypharmacy is a serious health issue for older adults worldwide, including in Japan, which has a rapidly aging society. The “Proper Medication Guideline for Older Adults” was published for healthcare providers in May 2018, and polypharmacy reduction incentives were initiated for medical facilities in April 2016 and April 2018. This study identified the long-term reduction in polypharmacy prescriptions focusing on older adults aged 75 years and above from April 2015 to March 2019. The national health insurance claims database, which covers most reimbursement claims in Japan, was selected as the primary data source. In this study, polypharmacy was defined as the simultaneous prescription of seven or more medications or multi-psychotropic medications. The primary outcome was the polypharmacy reduction ratio, which indicates the decrease in polypharmacy proportion based on the number of medications on an outpatient prescription. A total polypharmacy reduction of 19.3% for the “75–89 years” subgroup and 16.5% for the “90 years and above” subgroup was observed over four years. Based on prefecture analysis, the mean values of polypharmacy proportion showed a statistically significant reduction over four years. This study showed a successful nationwide reduction in polypharmacy prescriptions after implementing the polypharmacy management guidelines for older adults and incentive-based policies.

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Effects of medical service fee revision on reducing irrational psychotropic polypharmacy in Japan: an interrupted time-series analysis

Cited by 8 publications

References 21 publications

Impact of the expert consensus on polypharmacy and potentially inappropriate medication use in elderly lung cancer outpatients with multimorbidity: An interrupted time series analysis, 2016–2021

Impact of the expert consensus on polypharmacy and potentially inappropriate medication use in elderly lung cancer outpatients with multimorbidity: An interrupted time series analysis, 2016–2021

Regional difference in multi-psychotropic drug prescription in Japan and its associated factors: an ecological study using national health insurance claims data

Nationwide Long-Term Evaluation of Polypharmacy Reduction Policies Focusing on Older Adults in Japan

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