Analysis of the trends of polypharmacy and high‐dose prescriptions in Japan

Abstract

Introduction After extensive research, this study explored whether high‐dose prescriptions and polypharmacy remain more frequent in Japan than elsewhere. If confirmed, we aimed to identify the factors that contributed to this unique trend. Methods The psychotropic drug prescription patterns for patients with schizophrenia in Japan were reviewed. This was based on a large sample collected from surveys of the Research on Asian Psychotropic Prescription Patterns, an international collaborative research project conducted by Asian psychiatrists to monitor prescriptions of psychotropic drugs for people with mental disorders, in 2001, 2004, 2008, and 2016. Results The 2016 Research on Asian Psychotropic Prescription Patterns survey revealed that Japan continued to demonstrate the highest rate of polypharmacy and the highest dosages of psychotropic prescription drugs for patients with schizophrenia among the 15 countries and areas that participated in the survey. Discussion The Research on Asian Psychotropic Prescription Patterns surveys demonstrated that science plays a limited role in the decision‐making process for prescriptions of psychotropic medications. Such prescriptions are influenced by a wide range of factors, such as the national mental health policy, prescription‐financing systems, the history of psychiatry in each country, and the prevailing culture. Hospital‐based national mental health policies and mental health financing systems have been the primary obstacles to reducing polypharmacy in Japan.

Effect of education regarding treatment guidelines for schizophrenia and depression on the treatment behavior of psychiatrists: A multicenter study

“…The proportion of antipsychotic polypharmacy was not different between decades; however, regarding regions, the prevalence was higher in Asia and Europe than in North America. Research on Asian Psychotropic Prescription Patterns in 2016 examined the proportion of polypharmacy in patients with schizophrenia among 15 countries and areas in Asia 43 . These data demonstrated a continued declining trend of antipsychotic polypharmacy in Japan; however, Japan continued to demonstrate the highest proportion of polypharmacy and highest dosages of psychotropic prescription drugs in Asia 43 .…”

“…43 Although a polypharmacy reduction policy by the government, which reduces the reimbursement of medical costs, was introduced in 2014 and 2016, it seems to be insufficient. 43 National mental health policies based on hospitals and financing systems might be obstacles to reducing polypharmacy in Japan. The severity of major depressive disorder and polypharmacy in 44 000 patients in Europe from 2001 to 2017 suggests a trend toward polypharmacy depending on severity; however, changes in polypharmacy over time were not reported.…”

Regional difference in multi-psychotropic drug prescription in Japan and its associated factors: an ecological study using national health insurance claims data

“…In addition, psychiatrists may tend to conduct multi-psychotropic drug prescriptions because an association between psychiatrists and multi-psychotropic drug prescription or polypharmacy are shown in other countries [45][46][47]. Moreover, it is mentioned in a previous study that factors, such as physician's culture, patient's attitude, and lack of training in psychopharmacology are possible reasons why psychiatrists in Japan continue to prescribe multiple drugs and high doses of psychotropics compared with other countries [1].…”

“…Polypharmacy is one of the most frightening public health problems worldwide [1,2]. In Japan over the past few years, the prevalence of polypharmacy has decreased [3,4], while the prevalence of potentially inappropriate medications has increased [3].…”

A Comparison between Perceptions of Psychiatric Outpatients and Psychiatrists Regarding Benzodiazepine Use and Decision Making for Its Discontinuation: A Cross-Sectional Survey in Japan

“…However, according to a survey using a large-scale health insurance claims database conducted in 2021 by Takeshima et al, the mean duration of hypnotic prescriptions was 2.9 months, and 9.3% of patients were prescribed hypnotics for 12 months [ 11 ]. Moreover, an observational study using a Japan Medical Data Center dataset containing all medical fee data of health insurance service subscribers from 2015 to 2019 showed that the prescription of high-potency hypnotics (>15 mg/day diazepam) and anxiolytics (>2 mg/day flunitrazepam) generally remained unchanged [ 12 ]. These results suggest that the Japanese policies did not significantly affect long-term and high-dose BZD use.…”