Prevalence of Psychotropic Polypharmacy and Associated Healthcare Resource Utilization during Initial Phase of Care among Adults with Cancer in USA

Abstract

Background The use of psychotropic medications is not uncommon among patients with newly diagnosed cancer. However, the impact of psychotropic polypharmacy on healthcare utilization during the initial phase of cancer care is largely unknown. Methods We used a claims database to identify adults with incident breast, prostate, lung, and colorectal cancers diagnosed during 2011–12. Psychotropic polypharmacy was defined as concurrent use of two or more psychotropic medication classes for at least 90 days. A multivariable logistic regression was performed to identify significant predictors of psychotropic polypharmacy. Multivariable Poisson and negative binomial regressions were used to assess the associations between psychotropic polypharmacy and healthcare utilization. Results Among 5604 patients included in the study, 52.6% had breast cancer, 30.6% had prostate cancer, 11.4% had colorectal cancer, and 5.5% had lung cancer. During the year following incident cancer diagnosis, psychotropic polypharmacy was reported in 7.4% of patients, with the highest prevalence among patients with lung cancer (14.4%). Compared with patients without psychotropic polypharmacy during the initial phase of care, patients with newly diagnosed cancer with psychotropic polypharmacy had a 30% higher rate of physician office visits, an 18% higher rate of hospitalization, and a 30% higher rate of outpatient visits. The rate of emergency room visits was similar between the two groups. Conclusion Psychotropic polypharmacy during the initial phase of cancer care was associated with significantly increased healthcare resource utilization, and the proportion of patients receiving psychotropic polypharmacy differed by type of cancer. Impact Findings emphasize the importance of evidence-based psychotropic prescribing and close surveillance of events causing increased healthcare utilization among patients with cancer receiving psychotropic polypharmacy. Electronic supplementary material The online version of this article (10.1007/s40801-019-0153-5) contains supplementary material, which is available to authorized users.

Analysis of Psychotropics Polypharmacy and Prevalence of Non-Psychotropics Prescribed in Outpatient Psychiatry Unit of a Tertiary Care Teaching Hospital

“…Polypharmacy refers to the use of multiple medications for the treatment of a medical condition in a particular individual. 1,2 This definition often represents a quantitative estimation of the number of medicines prescribed rather than taking a holistic view on the clinical scenario wherein multiple coexisting diseases might demand the use of multiple medications. [1][2][3] The use of two or more psychotropic medications (Medicines belonging to similar class chemically or having a similar action profile) for management is the commonly used criteria for defining polypharmacy in psychiatry practice.…”

“…1,2 This definition often represents a quantitative estimation of the number of medicines prescribed rather than taking a holistic view on the clinical scenario wherein multiple coexisting diseases might demand the use of multiple medications. [1][2][3] The use of two or more psychotropic medications (Medicines belonging to similar class chemically or having a similar action profile) for management is the commonly used criteria for defining polypharmacy in psychiatry practice. [1][2][3][4][5] There has been an increasing trend in the practice of polypharmacy in psychiatry clinical practice with report suggesting a gradual decline in prevalence of monotherapy from 48% in 1980 to 20% in the decade from 1991-2000.…”

“…[1][2][3] The use of two or more psychotropic medications (Medicines belonging to similar class chemically or having a similar action profile) for management is the commonly used criteria for defining polypharmacy in psychiatry practice. [1][2][3][4][5] There has been an increasing trend in the practice of polypharmacy in psychiatry clinical practice with report suggesting a gradual decline in prevalence of monotherapy from 48% in 1980 to 20% in the decade from 1991-2000. 2,5 The current prevalence of polypharmacy ranges between 13-90%, with prescription pattern varying among different regions globally.…”

“…[1][2][3][4][5][6] Various factors have been considered to be the reason for a rising trend in polypharmacy which includes overlapping diagnostic criteria, misdiagnosis, diseases becoming refractory to the treatment, need for management of side-effects, insufficient patient compliance, misconception amongst treating fraternity that monotherapy is inadequate to treat psychiatric symptoms, research on various monoamines demonstrating clinical efficacy, Influence of pharmaceutical companies and multiple rapid drug approvals by various FDAs. [1][2][3][4][5][6] Polypharmacy is often regarded as a double-edged sword with obvious merits and demerits. Although lack of evidence discourages use of polypharmacy few support it for possible advantages like better symptomatic management, treating co-morbidities, decreased drug dosage, helps in switching over of medications and synergistic effect.…”

“…Although lack of evidence discourages use of polypharmacy few support it for possible advantages like better symptomatic management, treating co-morbidities, decreased drug dosage, helps in switching over of medications and synergistic effect. [1][2][3][4][5][6] Antipsychotics are often used in combination for treating schizophrenia as most commonly used antipsychotic medicines lack effect on negative symptoms and studies suggest up to 15-39% of schizophrenics experience a remission on monotherapy. [4][5][6] But, most experts prefer monotherapy over polypharmacy to avoid demerits of polypharmacy like increased incidence & severity of adverse drug reactions, toxicity, drug-drug interaction, medication errors, increased cost, pill count and non-compliance.…”