[Patterns of antidepressant dispensing among children and adolescents between 2015 and 2017 in the French region of Midi-Pyrenees]

BACKGROUND

In France, consumption of antidepressant drugs by children and teenagers has been on the rise, even though recommendations for use are limited due to their association with serious adverse reactions. The objective of this study was to describe the patterns of antidepressant drug dispensing among children and adolescents in the French region of Midi-Pyrenees.

METHOD

The data regarding the Midi-Pyrenees region were extracted from the French Health Insurance Database (SNDS) using their ATC codes. The reimbursements for antidepressants, benzodiazepines and neuroleptics dispensed to patients from 6 to 17 years old between January 2015 and June 2017 were analyzed, after which data on the antidepressants themselves were selected. The population was divided into sub-groups according to age (children : 6 to 11 years old, teenagers: 12 to 17 years old).

RESULTS

During the 30 months analyzed, 12,783 antidepressants were dispensed to 3506 patients. The antidepressants were primarily issued (90%) to teenagers. In terms of prevalence, 24.7% of the teenagers had amitriptyline delivered at least once, while 31.2% of them received sertraline at least once. Regarding total amount of antidepressant issuances, sertraline was first in both the child (26.9%) and the teenage (40.7%) populations. Benzodiazepine with an antidepressant was issued to 35.1% of the children and teenagers.

CONCLUSIONS

Amitriptyline was the most widely dispensed antidepressant among children, and sertraline among teenagers. However, fluoxetine is recommended as the first-line treatment for depression affecting this population. A psychotropic drug prescription assistance website such as psychotropes.fr addressed to general practitioners might improve the implementation of recommendations and guidelines.

Reasons for non-intensification of treatment in people with type 2 diabetes receiving oral monotherapy: Outcomes from the prospective DIAttitude study

OBJECTIVES

To describe the management of glucose-lowering agents in people with type 2 diabetes initially on oral monotherapy, cared for by French general practitioners, and to identify reasons underlying treatment non-intensification.

METHODS

People with type 2 diabetes on oral monotherapy were recruited by general practitioners and followed-up over 12 months. Patient characteristics, HbA1c, and glucose-lowering treatments were recorded electronically. Management objectives and reasons for treatment non-intensification were solicited from the general practitioners.

RESULTS

A total of 1212 patients were enrolled by 198 general practitioners; 937 patients (mean age 68 years) were treated with oral monotherapy, and 916 patients had at least two successive HbA1c values recorded. Of these, 390 patients (43%) had HbA1c≥6.5% on both occasions, and 164/390 (42%) had their treatment intensified. The 226 patients whose treatment was not intensified were older (69±11 years vs. 66±12 years, P=0.02) and had better glycaemic control at study inclusion (6.9%±0.6 vs. 7.3%±0.8, P<0.0001) than treatment intensified patients. Among uncontrolled patients, there were no differences in general practitioner treatment objectives at inclusion for treatment intensified and non-intensified patients; the main reason given by general practitioners for non-intensification was that the patient had an adequate HbA1c (66%). HbA1c did exceed the 6.5% target, but was less than 7.0% in 69% of cases.

CONCLUSIONS

General practitioners showed a patient-centred approach to treatment, but clinical inertia was apparent for 31% of the uncontrolled patients.

[Technical improvement of cohort constitution in administrative health databases: Providing a tool for integration and standardization of data applicable in the French National Health Insurance Database (SNIIRAM)]

AIM

Administrative health databases such as the French National Heath Insurance Database - SNIIRAM - are a major tool to answer numerous public health research questions. However the use of such data requires complex and time-consuming data management. Our objective was to develop and make available a tool to optimize cohort constitution within administrative health databases.

METHODS

We developed a process to extract, transform and load (ETL) data from various heterogeneous sources in a standardized data warehouse. This data warehouse is architected as a star schema corresponding to an i2b2 star schema model. We then evaluated the performance of this ETL using data from a pharmacoepidemiology research project conducted in the SNIIRAM database.

RESULTS

The ETL we developed comprises a set of functionalities for creating SAS scripts. Data can be integrated into a standardized data warehouse. As part of the performance assessment of this ETL, we achieved integration of a dataset from the SNIIRAM comprising more than 900 million lines in less than three hours using a desktop computer. This enables patient selection from the standardized data warehouse within seconds of the request.

CONCLUSION

The ETL described in this paper provides a tool which is effective and compatible with all administrative health databases, without requiring complex database servers. This tool should simplify cohort constitution in health databases; the standardization of warehouse data facilitates collaborative work between research teams.