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Qin X, Huckfeldt P, Abraham J, Yee D, Virnig BA. Generic entry of aromatase inhibitors and pharmaceutical access: Initiation of hormonal therapy, timeliness of initiation, and drug choice. Res Social Adm Pharm 2020; 17:1588-1595. [PMID: 33358400 DOI: 10.1016/j.sapharm.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 09/27/2020] [Accepted: 12/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The trade-offs between innovation and pharmaceutical access are central to the policy debate on drug pricing. High prices may limit access, result in medication underuse, and negatively affect outcomes. Generic drugs make treatments more affordable. Prior research measured access as utilization without a defined population that should receive certain drugs, it is unknown whether generic entry reduces underuse and thus improves access. OBJECTIVES To measure changes in access (use, timeliness) with the introduction of three generic aromatase inhibitors (AIs, oral breast cancer drugs) between June 2010 and June 2011. METHODS This population-based study included 93,650 older (65+) women diagnosed with hormone receptor-positive breast cancer between 2007 and 2013 in the Surveillance, Epidemiology and End Results-Medicare linked database. We examined changes in access with generic entry for initiation of any adjuvant hormonal therapy drug (AIs or tamoxifen) within one year of diagnosis, time from diagnosis to initiation, and choice of initial therapy. RESULTS Among 93,650 newly diagnosed breast cancer cases, 67,372 initiated one of the four drugs. With generic entry, initiation rates increased from 69.5% to 74.3%, but non-initiation remained high (up to 25.7%). After controlling for demographics, clinical factors, and insurance coverage, the probability of initiation increased by 4.6 percentage points (P < 0.001, 95%CI: [4.1,5.2]) after generic entry. With generic entry, estimated time to initiation decreased by 0.3 months (P < 0.001, 95%CI: [0.2,0.3]) from 4.1 months, and the probability of choosing AIs over tamoxifen increased by 5.9 percentage points (P < 0.001, 95%CI: [5.3,6.5]). Patterns did not substantially differ by level of cost-sharing. CONCLUSIONS Generic entry of AIs was associated with increased probability of receiving recommended treatments, timeliness of treatment, and the probability of receiving clinically preferred treatments. Price changes with generic entry only partially explained these improvements. High non-initiation rates after generic entry suggest prices are not the sole determinant of access.
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Affiliation(s)
- Xuanzi Qin
- Division of Health Policy & Management, School of Public Health, University of Minnesota, 420 Delaware St. S.E, Minneapolis, MN, 55455, USA.
| | - Peter Huckfeldt
- Division of Health Policy & Management, School of Public Health, University of Minnesota, 420 Delaware St. S.E, Minneapolis, MN, 55455, USA
| | - Jean Abraham
- Division of Health Policy & Management, School of Public Health, University of Minnesota, 420 Delaware St. S.E, Minneapolis, MN, 55455, USA
| | - Douglas Yee
- Masonic Cancer Center, University of Minnesota, 425 E. River Pkwy, Minneapolis, MN, 55455, USA
| | - Beth A Virnig
- Division of Health Policy & Management, School of Public Health, University of Minnesota, 420 Delaware St. S.E, Minneapolis, MN, 55455, USA
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Abstract
Heterogeneity is an important concept in psychiatric research and science more broadly. It negatively impacts effect size estimates under case-control paradigms, and it exposes important flaws in our existing categorical nosology. Yet, our field has no precise definition of heterogeneity proper. We tend to quantify heterogeneity by measuring associated correlates such as entropy or variance: practices which are akin to accepting the radius of a sphere as a measure of its volume. Under a definition of heterogeneity as the degree to which a system deviates from perfect conformity, this paper argues that its proper measure roughly corresponds to the size of a system's event/sample space, and has units known as numbers equivalent. We arrive at this conclusion through focused review of more than 100 years of (re)discoveries of indices by ecologists, economists, statistical physicists, and others. In parallel, we review psychiatric approaches for quantifying heterogeneity, including but not limited to studies of symptom heterogeneity, microbiome biodiversity, cluster-counting, and time-series analyses. We argue that using numbers equivalent heterogeneity measures could improve the interpretability and synthesis of psychiatric research on heterogeneity. However, significant limitations must be overcome for these measures-largely developed for economic and ecological research-to be useful in modern translational psychiatric science.
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Affiliation(s)
- Abraham Nunes
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Thomas Trappenberg
- Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
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Buhagiar K, Ghafouri M, Dey M. Oral antipsychotic prescribing and association with neighbourhood-level socioeconomic status: analysis of time trend of routine primary care data in England, 2011-2016. Soc Psychiatry Psychiatr Epidemiol 2020; 55:165-73. [PMID: 31630215 DOI: 10.1007/s00127-019-01793-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Increasing rates of antipsychotic prescribing have been reported previously, particularly for second-generation antipsychotics (SGAs), which are generally better tolerated than the older first-generation antipsychotics (FGAs). Prescribers, however, may exert bias, favouring prescriptions of novel drugs for patients of higher socioeconomic status (SES). We aimed to examine time trends in: (1) prescriptions of oral FGAs vs. SGAs and (2) associations between antipsychotic prescriptions and neighbourhood-level SES in England between 2011 and 2016. METHODS We used publicly available data for prescriptions made in primary care and linked general practices' postcodes with the Index of Multiple Deprivation (IMD) as a measure for neighbourhood-level SES. Absolute numbers of antipsychotic prescriptions were calculated. Linear regression analysis was used to examine the association of SGA vs. FGA prescription pattern with time and with SES. RESULTS A total of 27,486,000 oral antipsychotics were prescribed during the study period, mostly SGAs (n = 21,700,000; 78.9%). There was a significant increase in the ratio of SGA/FGA prescriptions over time (β = 0.376, 95% CI 0.277-0.464, P < 0.001). Individual FGAs were increasingly prescribed in areas of lower SES and the converse for SGAs except amisulpride. During the study period, a significantly larger proportion of total SGA prescriptions relative to total FGAs were made in areas of higher SES (β = 0.182, 95% CI 0.117-0.249, P < 0.001). CONCLUSION Prescriptions of antipsychotics continue to rise overall, with SGAs taking preference especially in areas of higher SES. The pattern of antipsychotic prescription favouring people in areas of lower social deprivation carries implications on inequalities even among sub-groups of people with mental disorders.
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Affiliation(s)
- Abraham Nunes
- From the Department of Psychiatry (Nunes, Alda) and the Faculty of Computer Science (Trappenberg, Nunes), Dalhousie University, Halifax, NS, Canada
| | - Thomas Trappenberg
- From the Department of Psychiatry (Nunes, Alda) and the Faculty of Computer Science (Trappenberg, Nunes), Dalhousie University, Halifax, NS, Canada
| | - Martin Alda
- From the Department of Psychiatry (Nunes, Alda) and the Faculty of Computer Science (Trappenberg, Nunes), Dalhousie University, Halifax, NS, Canada
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Metes ID, Xue L, Chang CCH, Huskamp HA, Gellad WF, Lo-Ciganic WH, Choudhry NK, Richards-Shubik S, Guclu H, Donohue JM. Association between physician adoption of a new oral anti-diabetic medication and Medicare and Medicaid drug spending. BMC Health Serv Res 2019; 19:703. [PMID: 31619229 PMCID: PMC6794771 DOI: 10.1186/s12913-019-4520-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/10/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In the United States, there is well-documented regional variation in prescription drug spending. However, the specific role of physician adoption of brand name drugs on the variation in patient-level prescription drug spending is still being investigated across a multitude of drug classes. Our study aims to add to the literature by determining the association between physician adoption of a first-in-class anti-diabetic (AD) drug, sitagliptin, and AD drug spending in the Medicare and Medicaid populations in Pennsylvania. METHODS We obtained physician-level data from QuintilesIMS Xponent™ database for Pennsylvania and constructed county-level measures of time to adoption and share of physicians adopting sitagliptin in its first year post-introduction. We additionally measured total AD drug spending for all Medicare fee-for-service and Part D enrollees (N = 125,264) and all Medicaid (N = 50,836) enrollees with type II diabetes in Pennsylvania for 2011. Finite mixture model regression, adjusting for patient socio-demographic/clinical characteristics, was used to examine the association between physician adoption of sitagliptin and AD drug spending. RESULTS Physician adoption of sitagliptin varied from 44 to 99% across the state's 67 counties. Average per capita AD spending was $1340 (SD $1764) in Medicare and $1291 (SD $1881) in Medicaid. A 10% increase in the share of physicians adopting sitagliptin in a county was associated with a 3.5% (95% CI: 2.0-4.9) and 5.3% (95% CI: 0.3-10.3) increase in drug spending for the Medicare and Medicaid populations, respectively. CONCLUSIONS In a medication market with many choices, county-level adoption of sitagliptin was positively associated with AD spending in Medicare and Medicaid, two programs with different approaches to formulary management.
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Affiliation(s)
- Ilinca D Metes
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A651, Pittsburgh, PA, 15261, USA
| | - Lingshu Xue
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A651, Pittsburgh, PA, 15261, USA
| | - Chung-Chou H Chang
- Department of Medicine, School of Medicine, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA, 15213, USA.,Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Haiden A Huskamp
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Walid F Gellad
- Department of Medicine, School of Medicine, University of Pittsburgh, 200 Meyran Avenue, Suite 200, Pittsburgh, PA, 15213, USA.,Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA.,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15215, USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32610, USA
| | - Niteesh K Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 1620 Tremont Street, Suite 3030, Boston, MA, 02120, USA
| | - Seth Richards-Shubik
- College of Business and Economics, Lehigh University, Rausch Business Center, Room 465, 621 Taylor St, Bethlehem, PA, 18015, USA
| | - Hasan Guclu
- Department of Statistics, School of Science, Istanbul Medeniyet University, Uskudar, 34700, Istanbul, Turkey
| | - Julie M Donohue
- Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA, 15261, USA. .,Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A635, Pittsburgh, PA, 15261, USA.
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Trombetta DP, Heller DA. Can Academic Detailing Move the Needle for Patients with Diabetes in a State-Based Prescription Drug Benefit Program? Am Health Drug Benefits 2019; 12:94-102. [PMID: 31057695 PMCID: PMC6485651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 10/17/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Publicly funded prescription drug programs, such as state pharmacy assistance programs, provide critical benefits for the care of individuals, but they are frequently limited in their resources to optimize patient outcomes. The application of quality metrics to prescription drug claims may help to determine whether prescribers' adherence to national standards can be augmented through academic detailing. OBJECTIVE To evaluate changes in diabetes drug prescribing patterns after an academic detailing educational intervention in 2013 and 2014 for prescribers in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program. METHODS We used a retrospective, quasiexperimental study design that applied interrupted time series and segmented regression analysis, and examined PACE pharmacy claims data for 1 year before and 1 year after the academic detailing intervention. Four diabetes prescribing metrics were evaluated at monthly intervals for a sample of 574 prescribers who received academic detailing and for a propensity score-matched comparison sample of 574 prescribers who did not receive the intervention. RESULTS The prescribers who received academic detailing did not differ significantly after the intervention from the providers who did not receive the intervention in their prescribing trends for the 4 diabetes metrics. The observed time series patterns suggest that diabetes-related ceiling effects were likely, with relatively small room for improvement at the group level during the study period. CONCLUSION The results of this study did not demonstrate group differences in prescribing trends that were attributable to the intervention. However, many prescribers in the detailed group had been exposed to similar educational outreach by PACE before 2013, which limits the interpretation of this finding. In addition, the diabetes quality metrics had been the standard of care during the preceding decade, with a broad dissemination of the treatment guidelines to the provider community. These results are consistent with a ceiling effect in the measured metrics, suggesting that most prescribers in both groups were largely following core diabetes guidelines before and after the intervention.
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Affiliation(s)
- Dominick P Trombetta
- Associate Professor, Pharmacy Practice, Wilkes University, School of Pharmacy, Wilkes-Barre, PA
| | - Debra A Heller
- Senior Health Outcomes Scientist, Magellan Rx Management/PACE, Harrisburg, PA
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Abstract
Introduction and objectives: There is a paucity of antipsychotic prescribing and utilization data in Pakistan that needs addressing, especially with issues of availability, affordability, gender differences, and domestic violence, to develop pertinent strategies. The objective of this study was to address these issues by describing current antipsychotic utilization patterns in Pakistan among adult patients attending tertiary care hospitals and private practitioners.Methods: A three staged approach was used including (1) assessment of total antipsychotic utilization, expenditure, and costs per unit between 2010 and 2015, (2) an in-depth retrospective study of prescribing patterns, including co-morbidities among representative hospital patients in Pakistan, and (3) assessment of the quality of prescribing against WHO targets.Results: Total use of antipsychotics increased 4.3-fold and the cost/unit increased by 13.2% during the study period. Risperidone and olanzapine were the most prescribed antipsychotics with more limited use of other typical and atypical antipsychotics. The number of medicines per encounter was 4.56. Prescription using generic instead of brand names was 21.4%. Seven per cent were prescribed more than one antipsychotic concurrently.Conclusion: There has been an appreciable increase in antipsychotic utilization in recent years in Pakistan, especially atypical antipsychotics, with little polypharmacy. Ongoing utilization of typical antipsychotics may be due to comorbidities such as diabetes and cardiovascular disease. Issues of international non-proprietary name prescribing need investigating along with the high number of medicines per encounter and gender inequality.
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Affiliation(s)
- Sidra Mahmood
- Department of Pharmacy, Quaid e Azam University, Islamabad, Pakistan
| | | | - Taufeeq Ur Rehman
- Department of Pharmacy, Quaid e Azam University, Islamabad, Pakistan
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Amanj Baker Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Health Economics Centre, Liverpool University Management School, Liverpool, UK
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, Guanteng Province, South Africa
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Brunette MF, Cotes RO, de Nesnera A, McHugo G, Dzebisashvili N, Xie H, Bartels SJ. Use of Academic Detailing With Audit and Feedback to Improve Antipsychotic Pharmacotherapy. Psychiatr Serv 2018; 69:1021-1028. [PMID: 29879874 PMCID: PMC6381589 DOI: 10.1176/appi.ps.201700536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Second-generation antipsychotics vary in their propensity to cause serious cardiometabolic side effects. In addition, use of two or more antipsychotics (polypharmacy) may lead to additive side effects and has not been shown to be consistently more effective than monotherapy. This study examined the use of academic detailing with audit and feedback to improve antipsychotic prescribing practices, including antipsychotic polypharmacy and utilization of medication with high or low risk of cardiometabolic side effects ("high risk" or "low risk," respectively). METHODS Four intervention sessions were provided over two years to psychiatric care providers at community mental health centers. Segmented regression within the general estimating equation model framework used Medicaid pharmacy claims to examine prescribing patterns before and after the intervention among all beneficiaries (67,721 person-months) over a five-year period. RESULTS After the intervention, 10.9% of beneficiaries with antipsychotic claims were on polypharmacy, compared with 13.1% before the invention. Use of high-risk and low-risk antipsychotics did not change. The final adjusted polypharmacy model showed that antipsychotic polypharmacy decreased among young adults and adults ages 40 or older compared with beneficiaries ages 30-39 (β=-.02, p=.04, and β=-.02, p=.007, respectively). The raw proportion of beneficiaries on high- and low-risk agents did not change, although final adjusted models demonstrated changes in use of high- and low-risk agents by diagnosis and risk group. CONCLUSIONS Polypharmacy decreased among young and older adults after academic detailing with audit and feedback. Although further research is needed, this low-intensity intervention may help mental health systems reduce antipsychotic polypharmacy.
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Affiliation(s)
- Mary F Brunette
- Dr. Brunette, Dr. de Nesnera, Dr. McHugo, Dr. Xie, and Dr. Bartels are with the Department of Psychiatry, Dartmouth-Hitchcock, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Brunette is also with the New Hampshire Department of Health and Human Services Bureau of Mental Health Services, Concord. Dr. Cotes is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Dzebisashvili is with Xyn Management. Inc., Boerne, Texas
| | - Robert O Cotes
- Dr. Brunette, Dr. de Nesnera, Dr. McHugo, Dr. Xie, and Dr. Bartels are with the Department of Psychiatry, Dartmouth-Hitchcock, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Brunette is also with the New Hampshire Department of Health and Human Services Bureau of Mental Health Services, Concord. Dr. Cotes is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Dzebisashvili is with Xyn Management. Inc., Boerne, Texas
| | - Alexander de Nesnera
- Dr. Brunette, Dr. de Nesnera, Dr. McHugo, Dr. Xie, and Dr. Bartels are with the Department of Psychiatry, Dartmouth-Hitchcock, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Brunette is also with the New Hampshire Department of Health and Human Services Bureau of Mental Health Services, Concord. Dr. Cotes is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Dzebisashvili is with Xyn Management. Inc., Boerne, Texas
| | - Gregory McHugo
- Dr. Brunette, Dr. de Nesnera, Dr. McHugo, Dr. Xie, and Dr. Bartels are with the Department of Psychiatry, Dartmouth-Hitchcock, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Brunette is also with the New Hampshire Department of Health and Human Services Bureau of Mental Health Services, Concord. Dr. Cotes is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Dzebisashvili is with Xyn Management. Inc., Boerne, Texas
| | - Nino Dzebisashvili
- Dr. Brunette, Dr. de Nesnera, Dr. McHugo, Dr. Xie, and Dr. Bartels are with the Department of Psychiatry, Dartmouth-Hitchcock, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Brunette is also with the New Hampshire Department of Health and Human Services Bureau of Mental Health Services, Concord. Dr. Cotes is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Dzebisashvili is with Xyn Management. Inc., Boerne, Texas
| | - Haiyi Xie
- Dr. Brunette, Dr. de Nesnera, Dr. McHugo, Dr. Xie, and Dr. Bartels are with the Department of Psychiatry, Dartmouth-Hitchcock, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Brunette is also with the New Hampshire Department of Health and Human Services Bureau of Mental Health Services, Concord. Dr. Cotes is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Dzebisashvili is with Xyn Management. Inc., Boerne, Texas
| | - Stephen J Bartels
- Dr. Brunette, Dr. de Nesnera, Dr. McHugo, Dr. Xie, and Dr. Bartels are with the Department of Psychiatry, Dartmouth-Hitchcock, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire. Dr. Brunette is also with the New Hampshire Department of Health and Human Services Bureau of Mental Health Services, Concord. Dr. Cotes is with the Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta. Dr. Dzebisashvili is with Xyn Management. Inc., Boerne, Texas
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Rege S, Sura S, Aparasu RR. Atypical antipsychotic prescribing in elderly patients with depression. Res Social Adm Pharm 2018; 14:645-652. [DOI: 10.1016/j.sapharm.2017.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/20/2017] [Accepted: 07/29/2017] [Indexed: 12/28/2022]
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Spertus J, Horvitz-Lennon M, Abing H, Normand SL. Risk of weight gain for specific antipsychotic drugs: a meta-analysis. NPJ Schizophr 2018; 4:12. [PMID: 29950586 DOI: 10.1038/s41537-018-0053-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/15/2017] [Accepted: 12/05/2017] [Indexed: 12/04/2022]
Abstract
People with schizophrenia are at considerably higher risk of cardiometabolic morbidity than the general population. Second-generation antipsychotic drugs contribute to that risk partly through their weight gain effects, exacerbating an already high burden of disease. While standard ‘as-randomized’ analyses of clinical trials provide valuable information, they ignore adherence patterns across treatment arms, confounding estimates of realized treatment exposure on outcome. We assess the effect of specific second-generation antipsychotics on weight gain, defined as at least a 7% increase in weight from randomization, using a Bayesian hierarchical model network meta-analysis with individual patient level data. Our data consisted of 14 randomized clinical trials contributing 5923 subjects (mean age = 39 [SD = 12]) assessing various combinations of olanzapine (n = 533), paliperidone (n = 3482), risperidone (n = 540), and placebo (n = 1368). The median time from randomization to dropout or trial completion was 6 weeks (range: 0–60 weeks). The unadjusted probability of weight gain in the placebo group was 4.8% across trials. For each 10 g chlorpromazine equivalent dose increase in olanzapine, the odds of weight gain increased by 5 (95% credible interval: 1.4, 5.3); the effect of risperidone (odds ratio = 1.6 [0.25, 9.1]) was estimated with considerable uncertainty but no different from paliperidone (odds ratio = 1.3 [1.2, 1.5]). People taking a commonly prescribed antipsychotic to treat schizophrenia have an increased risk of weight gain. Sharon-Lise Normand of Harvard Medical School in the US and colleagues analysed data from 14 randomized control trials representing almost 6000 people taking one of three antipsychotic drugs for schizophrenia, or a placebo. Using a unique statistical approach, they found that people taking the drug olanzapine had the highest risk of weight gain. People taking paliperidone had only a small risk, while there was uncertainty regarding the drug riperidone. Antipsychotic drugs can often be taken for decades, so understanding their cummulative effects on patient health is crucial to improving quality of life and preventing premature mortality. The method used in this study is unique and could be used to analyse other aspects of drug use.
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Janus SIM, Reinders GH, van Manen JG, Zuidema SU, IJzerman MJ. Psychotropic Drug-Related Fall Incidents in Nursing Home Residents Living in the Eastern Part of The Netherlands. Drugs R D 2018; 17:321-328. [PMID: 28389998 PMCID: PMC5427052 DOI: 10.1007/s40268-017-0181-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Older people are more susceptible to falls than younger people. Therefore, as the Dutch population ages, the total number of falls and costs associated with them will rise. The use of psychotropic drugs is associated with an increased risk of falling. To create tailored fall-prevention programmes, information on the magnitude of the association between fall incidents and specific psychotropic drugs or drug classes is needed. Objective The goal of this study was to delineate the associations between fall incidents and specific psychotropic drugs or drug classes. Methods In this retrospective cohort study, electronic patient records, medication records and fall incident reports were collected for 1415 residents receiving somatic or psychogeriatric care in 22 nursing homes in the eastern part of the Netherlands from May 2012 until March 2015. Using a Cox proportional hazards model, we analysed the magnitude of the association between psychotropic drugs and the risk of falling for users and non-users of the psychotropic drugs or drug classes. Results Antipsychotics (adjusted hazard ratio [aHR] 1.49; 95% confidence interval [CI] 1.12–2.00) and hypnotics and sedatives (aHR 1.51; 95% CI 1.13–2.02) increase the risk of falling. There was no difference between the risk incurred by typical and atypical antipsychotics. However, within these groups, there were differences between the most commonly prescribed drugs: haloperidol and quetiapine were seen to have an association with falls, whereas pipamperone and risperidone were not. Conclusions The results suggest falls may be associated with individual drugs rather than drug classes. Within the drug classes, clear differences are evident between individual drugs. Future fall-prevention programmes should highlight the differential risks involved with the use of specific psychotropic drugs, and doctors should take the fall risk into account when choosing specific drugs.
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Affiliation(s)
- Sarah I M Janus
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
| | - Gezinus H Reinders
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Jeannette G van Manen
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Sytse U Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Maarten J IJzerman
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
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Bahji A, Bajaj N. Gaps in Psychiatric Training Could Challenge Delivery of Optimal Schizophrenia Pharmacotherapy. Can J Psychiatry 2018; 63:146-147. [PMID: 29356612 PMCID: PMC5788136 DOI: 10.1177/0706743717739549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Anees Bahji
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
| | - Neeraj Bajaj
- Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
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Hálfdánarson Ó, Zoëga H, Aagaard L, Bernardo M, Brandt L, Fusté AC, Furu K, Garuoliené K, Hoffmann F, Huybrechts KF, Kalverdijk LJ, Kawakami K, Kieler H, Kinoshita T, Litchfield M, López SC, Machado-Alba JE, Machado-Duque ME, Mahesri M, Nishtala PS, Pearson SA, Reutfors J, Saastamoinen LK, Sato I, Schuiling-Veninga CCM, Shyu YC, Skurtveit S, Verdoux H, Wang LJ, Yahni CZ, Bachmann CJ. International trends in antipsychotic use: A study in 16 countries, 2005-2014. Eur Neuropsychopharmacol 2017; 27:1064-76. [PMID: 28755801 DOI: 10.1016/j.euroneuro.2017.07.001] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/05/2017] [Indexed: 11/23/2022]
Abstract
The objective of this study was to assess international trends in antipsychotic use, using a standardised methodology. A repeated cross-sectional design was applied to data extracts from the years 2005 to 2014 from 16 countries worldwide. During the study period, the overall prevalence of antipsychotic use increased in 10 of the 16 studied countries. In 2014, the overall prevalence of antipsychotic use was highest in Taiwan (78.2/1000 persons), and lowest in Colombia (3.2/1000). In children and adolescents (0-19 years), antipsychotic use ranged from 0.5/1000 (Lithuania) to 30.8/1000 (Taiwan). In adults (20-64 years), the range was 2.8/1000 (Colombia) to 78.9/1000 (publicly insured US population), and in older adults (65+ years), antipsychotic use ranged from 19.0/1000 (Colombia) to 149.0/1000 (Taiwan). Atypical antipsychotic use increased in all populations (range of atypical/typical ratio: 0.7 (Taiwan) to 6.1 (New Zealand, Australia)). Quetiapine, risperidone, and olanzapine were most frequently prescribed. Prevalence and patterns of antipsychotic use varied markedly between countries. In the majority of populations, antipsychotic utilisation and especially the use of atypical antipsychotics increased over time. The high rates of antipsychotic prescriptions in older adults and in youths in some countries merit further investigation and systematic pharmacoepidemiologic monitoring.
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Yazici E, S Cilli A, Yazici AB, Baysan H, Ince M, Bosgelmez S, Bilgic S, Aslan B, Erol A. Antipsychotic Use Pattern in Schizophrenia Outpatients: Correlates of Polypharmacy. Clin Pract Epidemiol Ment Health 2017; 13:92-103. [PMID: 29081826 PMCID: PMC5633702 DOI: 10.2174/1745017901713010092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 05/24/2017] [Accepted: 06/22/2017] [Indexed: 02/03/2023]
Abstract
Background: This study investigates the antipsychotic use patterns of patients with schizophrenia and its correlations in their daily drug use patterns. Methods: Patients with schizophrenia who have regular records at two different community counselling centres (CCS) were included in the study. Information about their medications and sociodemographic data was recorded through face-to-face interviews and supporting information about their drug use patterns was obtained from their relatives/caregivers/nurse. The Clinical Global Impression Scale (severity of illness) and the General Assessment of Functionality scales were also administered. Results: Patients with schizophrenia used 2.0 ± 0.81 antipsychotics daily and 3.52 ± 2.55 pills (1–18). Seventy-one percent of the patients used two or more kinds of psychotropic drugs. The most frequently used antipsychotics were quetiapine, a second generation antipsychotic, and haloperidol, a typical antipsychotic. Clinical severity, regular visits to a CCS and use of depot antipsychotics were independent predictors for polypharmacy. Conclusion: The rate of polypharmacy use is high in Turkey. There are multiple risk factors related with polipharmacy. New studies should focus risk factors for preventing polypharmacy.
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Affiliation(s)
- Esra Yazici
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Ali S Cilli
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Ahmet B Yazici
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Hayriye Baysan
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Mustafa Ince
- Kocaeli Derince Training and Research Hospital - Psychiatry Kocaeli, Kocaeli, Turkey
| | - Sukriye Bosgelmez
- Kocaeli Derince Training and Research Hospital - Psychiatry Kocaeli, Kocaeli, Turkey
| | - Serkan Bilgic
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Betul Aslan
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
| | - Atila Erol
- Department of Psychiatry, Sakarya University Medical Faculty Training and Research Hospital - Psychiatry Sakarya, Sakarya, Turkey
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Abstract
BACKGROUND A recent large database analysis raised concerns of potential acute kidney injury (AKI) risk associated with antipsychotics. However, whether individual atypical and typical antipsychotics are associated with differential AKI risks has not been investigated. OBJECTIVE The current study compared the risks of AKI and known causes of AKI associated with a broad range of atypical and typical antipsychotics. METHOD This retrospective cohort analysis used January 2007-June 2013 US nationwide Humana claims data to define episodes of antipsychotic drug therapy for patients with schizophrenia and bipolar disorder. Study drugs were aripiprazole, fluphenazine, haloperidol, olanzapine, quetiapine, risperidone, and ziprasidone. Study outcomes were hospitalizations with AKI, and known causes of AKI, i.e., hypotension, acute urinary retention, neuroleptic malignant syndrome/rhabdomyolysis, and pneumonia. AKI was the primary outcome of the study. Cox regressions using haloperidol as the baseline comparator were used to estimate the impact of alternative antipsychotics on the risks of study adverse events following the initiation of treatment. The Cox models controlled for treatment history, comorbidities, and concomitant drug use in the prior 6 months. They also controlled for patient demographics and dose of current treatment. RESULTS The overall incidence of AKI was 25.0 per 1000 person-years. According to our multivariate regression results, the risk of AKI was significantly increased in patients taking olanzapine [hazard ratio (HR) 1.344, 95% confidence interval (CI) 1.057-1.708], quetiapine (HR 1.350, 95% CI 1.082-1.685), and ziprasidone (HR 1.338, 95% CI 1.035-1.729) relative to haloperidol. Aripiprazole (HR 1.152, 95% CI 0.908-1.462) and risperidone (HR 1.147, 95% CI 0.923-1.426) had insignificantly higher risks of AKI compared with haloperidol, whereas fluphenazine (HR 0.729, 95% CI 0.483-1.102) had an insignificantly lower risk of AKI. When compared between drug classes, atypical antipsychotics had a significantly higher risk of AKI (HR 1.313, 95% CI 1.083-1.591) than typical antipsychotics. CONCLUSIONS Antipsychotics are associated with differential AKI risks, with several atypical antipsychotics having higher risks than haloperidol. However, the overall incidence of AKI was moderate, and AKI risk should only raise concern for clinicians with elderly patients or patients who are vulnerable to kidney disease.
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Lo-Ciganic WH, Gellad WF, Huskamp HA, Choudhry NK, Chang CCH, Zhang R, Jones BL, Guclu H, Richards-Shubik S, Donohue JM. Who Were the Early Adopters of Dabigatran?: An Application of Group-based Trajectory Models. Med Care 2016; 54:725-32. [PMID: 27116109 PMCID: PMC4907845 DOI: 10.1097/mlr.0000000000000549] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Variation in physician adoption of new medications is poorly understood. Traditional approaches (eg, measuring time to first prescription) may mask substantial heterogeneity in technology adoption. OBJECTIVE Apply group-based trajectory models to examine the physician adoption of dabigratran, a novel anticoagulant. METHODS A retrospective cohort study using prescribing data from IMS Xponent™ on all Pennsylvania physicians regularly prescribing anticoagulants (n=3911) and data on their characteristics from the American Medical Association Masterfile. We examined time to first dabigatran prescription and group-based trajectory models to identify adoption trajectories in the first 15 months. Factors associated with rapid adoption were examined using multivariate logistic regressions. OUTCOMES Trajectories of monthly share of oral anticoagulant prescriptions for dabigatran. RESULTS We identified 5 distinct adoption trajectories: 3.7% rapidly and extensively adopted dabigatran (adopting in ≤3 mo with 45% of prescriptions) and 13.4% were rapid and moderate adopters (≤3 mo with 20% share). Two groups accounting for 21.6% and 16.1% of physicians, respectively, were slower to adopt (6-10 mo post-introduction) and dabigatran accounted for <10% share. Nearly half (45.2%) of anticoagulant prescribers did not adopt dabigatran. Cardiologists were much more likely than primary care physicians to rapidly adopt [odds ratio (OR)=12.2; 95% confidence interval (CI), 9.27-16.1] as were younger prescribers (age 36-45 y: OR=1.49, 95% CI, 1.13-1.95; age 46-55: OR=1.34, 95% CI, 1.07-1.69 vs. >55 y). CONCLUSIONS Trajectories of physician adoption of dabigatran were highly variable with significant differences across specialties. Heterogeneity in physician adoption has potential implications for the cost and effectiveness of treatment.
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Affiliation(s)
- Wei-Hsuan Lo-Ciganic
- Department of Pharmacy, Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ 85719, USA
- Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Walid F. Gellad
- Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
| | - Haiden A. Huskamp
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
| | - Niteesh K. Choudhry
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Chung-Chou H. Chang
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Ruoxin Zhang
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Bobby L. Jones
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA
| | - Hasan Guclu
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Statistics Department, Istanbul Medeniyet University, Istanbul, Turkey 34700
| | - Seth Richards-Shubik
- Department of Economics, College of Business and Economics, Lehigh University, Bethlehem, PA 18015
| | - Julie M. Donohue
- Center for Pharmaceutical, Policy and Prescribing, Health Policy Institute, University of Pittsburgh, Pittsburgh, PA 15261, USA
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
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Tang Y, Chang CCH, Lave JR, Gellad WF, Huskamp HA, Donohue JM. Patient, Physician and Organizational Influences on Variation in Antipsychotic Prescribing Behavior. J Ment Health Policy Econ 2016; 19:45-59. [PMID: 27084793 PMCID: PMC4834853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 12/07/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Physicians face the choice of multiple ingredients when prescribing drugs in many therapeutic categories. For conditions with considerable patient heterogeneity in treatment response, customizing treatment to individual patient needs and preferences may improve outcomes. AIMS OF THE STUDY To assess variation in the diversity of antipsychotic prescribing for mental health conditions, a necessary although not sufficient condition for personalizing treatment. To identify patient caseload, physician, and organizational factors associated with the diversity of antipsychotic prescribing. METHODS Using 2011 data from Pennsylvania's Medicaid program, IMS Health's HCOSTM database, and the AMA Masterfile, we identified 764 psychiatrists who prescribed antipsychotics to 10 patients. We constructed three physician-level measures of diversity/concentration of antipsychotic prescribing: number of ingredients prescribed, share of prescriptions for most preferred ingredient, and Herfindahl-Hirschman index (HHI). We used multiple membership linear mixed models to examine patient caseload, physician, and healthcare organizational predictors of physician concentration of antipsychotic prescribing. RESULTS There was substantial variability in antipsychotic prescribing concentration among psychiatrists, with number of ingredients ranging from 2-17, share for most preferred ingredient from 16%-85%, and HHI from 1,088-7,270. On average, psychiatrist prescribing behavior was relatively diversified; however, 11% of psychiatrists wrote an average of 55% of their prescriptions for their most preferred ingredient. Female prescribers and those with smaller shares of disabled or serious mental illness patients had more concentrated prescribing behavior on average. DISCUSSION Antipsychotic prescribing by individual psychiatrists in a large state Medicaid program varied substantially across psychiatrists. Our findings illustrate the importance of understanding physicians' prescribing behavior and indicate that even among specialties regularly prescribing a therapeutic category, some physicians rely heavily on a small number of agents. IMPLICATIONS FOR HEALTH POLICIES, HEALTH CARE PROVISION AND USE Health systems may need to offer educational interventions to clinicians in order to improve their ability to tailor treatment decisions to the needs of individual patients. IMPLICATIONS FOR FUTURE RESEARCH Future studies should examine the impact of the diversity of antipsychotic prescribing to determine whether more diversified prescribing improves patient adherence and outcomes.
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Affiliation(s)
- Yan Tang
- Center for Pharmaceutical Policy and Prescribing (CP3), Health Policy Institute, University of Pittsburgh; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, PA, USA, 130 DeSoto Street, Crabtree Hall A645, Pittsburgh, PA 15261, USA,
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Niedrig DF, Gött C, Fischer A, Müller ST, Greil W, Bucklar G, Russmann S. Second-generation antipsychotics in a tertiary care hospital: prescribing patterns, metabolic profiles, and drug interactions. Int Clin Psychopharmacol 2016; 31:42-50. [PMID: 26473524 DOI: 10.1097/YIC.0000000000000103] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We carried out an observational study that analyzed population characteristics, metabolic profiles, potentially interacting pharmacotherapy, and related adverse events in second-generation antipsychotics (SGAs) users of a tertiary care hospital. Within our pharmacoepidemiological database derived from electronic medical records of 82,358 hospitalizations, we identified 1136 hospitalizations contributing 9165 patient-days with exposure to SGA. Blood pressure, blood glucose, lipids, and BMI had been documented in 97.7, 75.7, 24.6, and 77.4% of hospitalizations, respectively. Among these, the prevalence of hypertension, hyperglycemia, dyslipidemia, and BMI 30 kg/m or more was 36.9, 22.6, 61.1, and 23.1%, respectively. A total of 63.4, 70.8, and 37.1% of SGA users with hyperglycemia, dyslipidemia, and hypertension, respectively, received no pharmacotherapy for these conditions. We identified 614 patient-days with SGA plus formally contraindicated comedication and another 1066 patient-days with other high-risk combinations for QTc prolongation. Among those there was one case with associated neutropenia and four cases with abnormal QTc interval. However, specific monitoring for such adverse events was not documented in 45.5% of hospitalizations with contraindicated and 89.8% with high-risk QTc-prolonging combinations. Our study identified targets for improved monitoring and management in SGA users. These may be implemented as automated alerts into electronic prescribing systems and thereby efficiently support safer pharmacotherapy in clinical practice.
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Lockwood JT, Remington G. Emerging drugs for antipsychotic-induced tardive dyskinesia: investigational drugs in Phase II and Phase III clinical trials. Expert Opin Emerg Drugs 2015; 20:407-21. [DOI: 10.1517/14728214.2015.1050376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Nevo ON, Gold J, Hawk S. Evaluation of a prior authorization policy on compliance with VA pharmacy benefits management services recommendations for antipsychotic selection. Ment Health Clin 2015. [DOI: 10.9740/mhc.2015.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction:
A previous study at Veterans Affairs (VA) Eastern Colorado Health Care System revealed low rates of compliance with VA Pharmacy Benefits Management Services recommendations for antipsychotic selection in schizophrenia and schizoaffective disorders. As a result, formulary restrictions of second-line antipsychotics were implemented. Since April 2013, new starts of second-line antipsychotic agents require a prior authorization drug review. The objectives of this study were to evaluate the impact of the prior authorization process on compliance with the VA criteria for prescribing aripiprazole, olanzapine, and ziprasidone. The primary objective was to compare compliance rates with VA antipsychotic selection criteria preimplementation and postimplementation of the prior authorization drug review policy.
Methods
Single center, retrospective chart review of patients receiving aripiprazole, olanzapine, and ziprasidone. A report of all patients receiving a prescription for the above 3 agents between April 8, 2013, and December 6, 2013, was generated from the electronic medical record system. Charts were reviewed manually to determine compliance.
Results
One hundred forty-two unique patients were started on aripiprazole, olanzapine, and/or ziprasidone. Ninety percent of patients met VA criteria for use of these second-line antipsychotic agents, compared to 26% of patients prior to implementation of the prior authorization drug review. Overall prescribing of these agents decreased by 60%, resulting in an estimated cost avoidance of $617 389.
Discussion
Implementation of a prior authorization drug request for aripiprazole, olanzapine, and ziprasidone was associated with increased compliance with VA criteria for use of antipsychotic agents and with marked cost avoidance due to the reduced use of more expensive second-line antipsychotic agents.
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Affiliation(s)
- Ofir Noah Nevo
- (Corresponding author) PGY2 Psychiatric Pharmacy Resident, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado,
| | - Jeffrey Gold
- Mental Health Clinical Pharmacy Specialist, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
| | - Sherri Hawk
- Pharmacoeconomist and Clinical Pharmacist, Veterans Affairs Eastern Colorado Health Care System, Denver, Colorado
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Anderson TS, Huskamp HA, Epstein AJ, Barry CL, Men A, Berndt ER, Horvitz-Lennon M, Normand SL, Donohue JM. Antipsychotic prescribing: do conflict of interest policies make a difference? Med Care 2015; 53:338-45. [PMID: 25769055 DOI: 10.1097/MLR.0000000000000329] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Academic medical centers (AMCs) have increasingly adopted conflict of interest policies governing physician-industry relationships; it is unclear how policies impact prescribing. OBJECTIVES To determine whether 9 American Association of Medical Colleges (AAMC)-recommended policies influence psychiatrists' antipsychotic prescribing and compare prescribing between academic and nonacademic psychiatrists. RESEARCH DESIGN We measured number of prescriptions for 10 heavily promoted and 9 newly introduced/reformulated antipsychotics between 2008 and 2011 among 2464 academic psychiatrists at 101 AMCs and 11,201 nonacademic psychiatrists. We measured AMC compliance with 9 AAMC recommendations. Difference-in-difference analyses compared changes in antipsychotic prescribing between 2008 and 2011 among psychiatrists in AMCs compliant with ≥ 7/9 recommendations, those whose institutions had lesser compliance, and nonacademic psychiatrists. RESULTS Ten centers were AAMC compliant in 2008, 30 attained compliance by 2011, and 61 were never compliant. Share of prescriptions for heavily promoted antipsychotics was stable and comparable between academic and nonacademic psychiatrists (63.0%-65.8% in 2008 and 62.7%-64.4% in 2011). Psychiatrists in AAMC-compliant centers were slightly less likely to prescribe these antipsychotics compared with those in never-compliant centers (relative odds ratio, 0.95; 95% CI, 0.94-0.97; P < 0.0001). Share of prescriptions for new/reformulated antipsychotics grew from 5.3% in 2008 to 11.1% in 2011. Psychiatrists in AAMC-compliant centers actually increased prescribing of new/reformulated antipsychotics relative to those in never-compliant centers (relative odds ratio, 1.39; 95% CI, 1.35-1.44; P < 0.0001), a relative increase of 1.1% in probability. CONCLUSIONS Psychiatrists exposed to strict conflict of interest policies prescribed heavily promoted antipsychotics at rates similar to academic psychiatrists and nonacademic psychiatrists exposed to less strict or no policies.
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Kelly J, Kelly F, Santlal K, O'Ceallaigh S. The impact of a change in prescribing policy on antipsychotic prescribing in a general adult psychiatric hospital. Ir J Psychol Med 2014; 31:167-73. [PMID: 30189484 DOI: 10.1017/ipm.2014.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To examine the impact of a change in local prescribing policy on the adherence to evidence-based prescribing guidelines for antipsychotic medication in a general adult psychiatric hospital. METHODS All adult in-patients had their clinical record and medication sheet reviewed. Antipsychotic prescribed, dose prescribed and documented indications for prescribing were recorded. This was done before and after the implementation of the change in hospital antipsychotic prescribing policy. RESULTS There were no significant differences in age, sex, Mental Health Act status, psychiatric diagnosis or documented indications for prescribing multiple or high dose antipsychotics between the two groups. There was an increase in the preferential prescribing of multiple second-generation antipsychotics (p=0.01) in the context of a significant reduction in the prescribing of multiple antipsychotics overall (p=0.02). There were no significant reductions in prescribing of mixed generations of antipsychotics (p=0.12), high dose antipsychotics (p=1.00) or as required (PRN) antipsychotics (p=0.74). CONCLUSIONS Changes in local prescribing policy can improve adherence to quality prescribing guidelines and cause clinically significant improvements in patterns of prescribing in a general adult psychiatric hospital.
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