Use of prevalence and incidence measures to describe age-related prescribing of antidepressants with and without anticholinergic effects

Reducing prescribing of highly anticholinergic antidepressants for elderly people: randomised trial of group versus individual academic

“…All reimbursable drugs for the insured population are registered this way. 14 24 The box gives the classification of antidepressant drugs marketed in the Netherlands.…”

“…Depending on the length of the visit and the responses of the professionals, the following items were discussed (in order): altered pharmacodynamics and kinetics in elderly people, 18 19 increased vulnerability of elderly people to side effects, 20 21 the need to avoid anticholinergic antidepressants in elderly people,22 and difficulties in diagnosing depression, especially in elderly people 17. Participants were shown the overall data on prescribing of antidepressants in the past year to illustrate that most anticholinergic antidepressants are prescribed to people aged over 60 14. The initial visits included no further comment on personal performance.…”

“…To define incident users of antidepressants, we used the prescription reimbursement records described above. For each prescription we calculated the number of days the prescription would cover, using the prescribed daily dose and the package size 14. In this way, a time window of probable use was created.…”

“…This study was designed to evaluate the ability of academic detailing given to individuals and groups to influence prescribing patterns. We selected antidepressant drugs for elderly people as the focus for the study because analyses of dispensing data14 and other studies15 have shown that a substantial portion of patients aged over 60 are prescribed highly anticholinergic antidepressants despite their greater susceptibility to hazardous side effects such as dry mouth, blurred vision, constipation, urinary dysfunction, hypotension, tachycardia, and cognitive impairment 16 – 23. We wanted to increase the awareness of the vulnerability of elderly people to anticholinergic side effects and decrease the prescribing of highly anticholinergic antidepressants (such as tertiary amine tricyclics) in this group while encouraging the use of less anticholinergic antidepressants such as secondary amines or selective serotonin reuptake inhibitors when indicated.…”

Analysis of medical prescriptions dispensed at health centers in Belo Horizonte, Minas Gerais, Brazil

“…As a general policy for ra t i o n a l p re s c ription, the World Health Org a n i z a t i o n (WHO) 3 recommends establishing national s t a n d a rds focusing on quality of pre s c ri p t i o n data; evaluating data on drug use in medical and pharmaceutical practices and re p o rt i n g such information through a formal network ; and educational pro g rams for health care prof e s s i o n a l s. Drug use measurements have been applied as indicators of quality of pre s c ri b e r behavior and to accredit health care org a n i z ations by assessing optimal drug use 4 . Analysis of pre s c ription data could provide the basis for reviewing pre s c ription practices and deve lo ping measures to promote the rational use of d rugs and pre vent dru g -related problems 5 . Acc o rding to the WHO 6 , the rational use of dru g s re q u i res that patients re c e i ve medications ap-p ro p riate to their clinical needs, in doses that meet their own individual re q u i re m e n t s, for an adequate period of time, and at the lowest cost to them and their community.…”