Factors Associated with the Type of Psychotropic Medications Purchased for Common Mental Disorders in the Largest Managed Care Organization in Israel

Abstract

Contrary to clinical guidelines, the purchase of anti-anxiety medications is more prevalent than the purchase of antidepressant medications. In a managed care setting, patient characteristics have a greater role in determining purchasing patterns than provider characteristics; potentially, because of the managed care characteristics that actively guide the care provided to patients.

Epidemic Use of Benzodiazepines among Older Adults in Israel: Epidemiology and Leverage Points for Improvement

“…Decision-support systems could prompt physicians to consider depression or dementia in older adults with insomnia or anxiety who might otherwise be prescribed benzodiazepines/BDZRAs, and help them target therapy to the underlying mental health condition. 1,2 Recent reforms to better integrate mental health services into Israeli health plans have created a timely opportunity to develop and implement such programs.…”

“…Benzodiazepines are commonly prescribed in many countries, including Israel. [1][2][3][4][5][6][7][8] This is problematic because these drugs can cause substantial harm. In older adults, benzodiazepine use increases the risk of falls, fracture, cognitive impairment, motor vehicle accidents, and other adverse outcomes.…”

“…9,12,13 Previous studies have documented the frequency of and risk factors for benzodiazepine and BDZRA use in different settings. [1][2][3][4][5][6][7][8]14 However, much less is known about potential leverage points that can be targeted to reduce high-risk use. The best opportunities may lie in curtailing the initiation of these drugs and preventing the transition from acute or intermittent use to chronic use, as it is very difficult to discontinue benzodiazepines in patients who have been using them chronically, even with comprehensive interventions.…”