Characteristics of Medicaid Recipients Receiving Persistent Antipsychotic Polypharmacy

Cotes, Robert O.; Goldsmith, David R.; Kopelovich, Sarah L.; Lally, Cathy; Druss, Benjamin G.

doi:10.1007/s10597-017-0183-y

Cited by 10 publications

(6 citation statements)

References 64 publications

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“…16 In 2012, their APP rate was 24.6%. 16 Cotes et al 17 found an APP rate of 19% on Medicaid recipients prescribed with AP. In addition, a meta -analysis 12 found a global median of 19.5% of patients on APP.…”

Section: Discussionmentioning

confidence: 99%

Antipsychotic Polypharmacy and High Doses in a Rural Portuguese Community Mental Health Service

Ramos¹,

Cruz

Jesus

et al. 2021

RPPSM

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Introduction: Antipsychotic polypharmacy (APP) and high dose (APHD) remain a common practice in the treatment of severe mental illness, even though they are not supported by current international guidelines. Methods: We aimed to establish the prescribing patterns of antipsychotics in a community mental health service in a rural setting, to determine the prevalence of APP and APHD treatment and to identify associated factors. Results: We identified 284 patients. APP was present in 46.5% patients and was associated to younger age, single status, more previous psychiatric admissions, and anticholinergic prescription. Prescription of APHD was observed in 14.4% patients and was associated with previous inpatient admissions, being prescribed with a first generation long‑acting injectable antipsychotic and anticholinergics. We also found that APP and APHD were mutually associated. Conclusion: Despite current guidelines, we found prevalences of APP and APHD of 46.5% and 14.4%, respectively. Further studies are necessary to better evaluate the antipsychotic prescription patterns in Portugal.

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Section: Discussionmentioning

confidence: 99%

Antipsychotic Polypharmacy and High Doses in a Rural Portuguese Community Mental Health Service

Ramos¹,

Cruz

Jesus

et al. 2021

RPPSM

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“…Additionally, the rate of antipsychotic polypharmacy (APP) has reached up to 40% (Cotes et al. , 2018 ) despite clinical practice recommendations emphasizing monotherapy (Galletly et al. , 2016 ; Hasan et al.…”

Section: Introductionmentioning

confidence: 99%

Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data

Laforgue,

Istvan,

Chaslerie

et al. 2023

Epidemiol Psychiatr Sci

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Aims Despite recommendations to initiate clozapine after two unsuccessful trials of antipsychotics, clozapine is underprescribed and initiated too late. The aim of this study was to describe different antipsychotic treatment sequences in the 36 months before the initiation of clozapine and to characterize clusters of treatment trajectories. Methods Using the French National Health Insurance database, a historical cohort study of the population in an area in western France was performed. The data from all new users of clozapine with a diagnosis of schizophrenia or schizoaffective disorder in the period of 2017–2018 were evaluated. All outpatient reimbursements for antipsychotics during the 36 months before clozapine initiation were analysed. Successive reimbursements for identical treatments were grouped into treatment trials (TTs), and different trajectories were clustered using a state sequence analysis. Results The results showed 1191 TTs for 287 individuals. The mean number of TTs per individual was 3.2. Risperidone, aripiprazole and haloperidol were the main treatments delivered. The frequencies of antipsychotics used differed between monotherapies and combination therapies. A three-cluster typology was identified: one cluster (n = 133) of ‘less treated’ younger individuals with fewer TTs and shorter TT durations; a second cluster (n = 53) of ‘more treated’ individuals with higher numbers of TTs and combinations of antipsychotics; and a third cluster (n = 103) of ‘treatment-stable’ older individuals with longer TT durations. Conclusions The results indicate that the median number of TTs during the 36 months before clozapine prescription was higher than the two recommended. The different trajectories were associated with individual characteristics and treatment differences, suggesting that additional studies of clinical parameters are needed to understand barriers to clozapine prescription.

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“…La polifarmacia es frecuente en la práctica clínica psiquiátrica a nivel mundial (1,2) y también en nuestro medio (3) . Los adultos mayores (≥65 años) son una población vulnerable a la polifarmacia, debido principalmente a los cambios fisiológicos que repercuten en aspectos farmacocinéticos y farmacodinámicos.…”

Section: Introductionunclassified

Seguridad del paciente Análisis de la prescripción en adultos mayores de una policlínica de salud mental del Hospital Vilardebó, Uruguay

2022

RMU

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Introducción: los pacientes con 65 años o más, por su condición fisiológica, tienen mayor probabilidad de estar expuestos a reacciones adversas a medicamentos. Algunos riesgos están asociados a la carga anticolinérgica de la medicación, y otros al perfil de seguridad de cada uno de los fármacos.Objetivo: realizar un análisis de los tratamientos farmacológicos para los pacientes ≥65 años y su posible implicancia en la clínica, por los riesgos potenciales debido a reacciones adversas.Método: se realizó un estudio descriptivo, transversal, observacional, naturalístico, del tratamiento farmacológico de los pacientes ≥65 años de la policlínica del Hospital Vilardebó, entre mayo y agosto de 2021. Se calculó la carga anticolinérgica de los tratamientos y se efectuó una comparación de dicha carga con la de una muestra de pacientes menores de 65 años.Resultados: 356 pacientes (83,0%) ≥65 años tenían un riesgo alto de tener algún efecto por su carga anticolinérgica y este riesgo fue similar a los pacientes menores de 65 años. Un total de 344 pacientes estaban en tratamiento con alguna benzodiazepina, destacándose el uso de flunitrazepam (47,6%) y clonazepam (32,6%). A 289 pacientes (67,4%) se le prescribió algún antipsicótico y nueve pacientes estaban con más de dos antipsicóticos. Dos pacientes estaban en tratamiento con imipramina y 49 pacientes recibían algún antiparkisoniano.Conclusiones: los pacientes mayores de 65 años están expuestos a riesgos altos de padecer reacciones adversas a medicamentos como consecuencia de una alta carga anticolinérgica (similar a la de la población más joven estudiada) y de una acentuada polifarmacia. Además, se deberían evitar algunas prácticas, como la prescripción de ciertos tipos de benzodiacepinas, así como minimizar el uso de imipramina y antiparkisonianos.Es necesario buscar estrategias de formación que disminuyan o minimicen este potencial riesgo que repercute adversamente en la salud de los pacientes.

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Characteristics of Medicaid Recipients Receiving Persistent Antipsychotic Polypharmacy

Cited by 10 publications

References 64 publications

Antipsychotic Polypharmacy and High Doses in a Rural Portuguese Community Mental Health Service

Antipsychotic Polypharmacy and High Doses in a Rural Portuguese Community Mental Health Service

Characterization of antipsychotic utilization before clozapine initiation for individuals with schizophrenia: an innovative visualization of trajectories using French National Health Insurance data

Seguridad del paciente Análisis de la prescripción en adultos mayores de una policlínica de salud mental del Hospital Vilardebó, Uruguay

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