National Prescribing Trends for High‐Risk Anticholinergic Medications in Older Adults

Rhee, Taeho Greg; Choi, Yoon Hee; Ouellet, Gregory M.; Ross, Joseph S.

doi:10.1111/jgs.15357

Cited by 35 publications

(62 citation statements)

References 19 publications

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“…PCPs treating older patients with common dermatological conditions prescribed FGAs in 7·4% of visits. This is consistent with previous work using data from NAMCS that showed that a ‘high‐risk anticholinergic prescription’ (including, but not limited to, antihistamines) was prescribed in 6·2% of office visits for older patients . In comparison, dermatologists prescribed FGAs in 3·9% of visits with common dermatological diagnoses and similar patient characteristics.…”

Section: Discussionsupporting

confidence: 89%

“…The goal was to identify possible factors associated with FGA prescription in older adults. Factors considered were age (65–74 years vs. ≥ 75 years), sex, race (white vs. nonwhite), insurance type (private vs. nonprivate), reason for the office visit (chronic vs. nonchronic problem), the presence of two or more chronic conditions, polypharmacy, a diagnosis of dermatitis or pruritus, and listing itch as a symptom . Following the univariate analyses, we performed multivariate logistic regression to assess whether any of the risk factors identified in the unadjusted analyses remained associated in the adjusted analysis.…”

Section: Methodsmentioning

confidence: 99%

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A multiyear cross‐sectional study of U.S. national prescribing patterns of first‐generation sedating antihistamines in older adults with skin disease

et al. 2019

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Summary Background First‐generation antihistamines (FGAs) are classified as ‘potentially inappropriate’ for use in older patients (patients aged ≥ 65 years). However, the prevalence of and factors associated with FGA prescription have not been studied. Objectives To examine FGA prescription rates for older patients who visited dermatology offices, and compare them to those for younger patients (patients aged 18–65 years) who visited dermatology offices and those for older patients who visited primary‐care physicians (PCPs). Methods This was a multiyear cross‐sectional observational study using data from the U.S. National Ambulatory Medical Care Survey (2006–2015). Visits by patients aged 18 years or older were included in the study; the data comprised 15 243 dermatology office visits and 66 036 PCP office visits. The main outcome was FGA prescription. Other variables included physician specialty (dermatologist or PCP), patient's age, diagnosis of dermatological conditions and reason for visit. Results For dermatology visits, the overall FGA prescription rate for older patients was similar to that for younger patients (1·5% vs. 1·2%; P = 0·19), even when the diagnosis was dermatitis or pruritus (3·7% vs. 4·8%; P = 0·21) or when itch was a complaint (7·6% vs. 6·7%; P = 0·64). However, the rate of FGA prescription for dermatology visits was lower than that for PCP visits, in analyses matched for patient and visit characteristics (3·9% vs. 7·4%; P = 0·02). Conclusions Our findings suggest that FGAs are overprescribed to older patients but that dermatologists are less likely to prescribe FGAs than PCPs. What's already known about this topic? First‐generation antihistamines (FGAs) have been shown to pose substantial risks to older adults, including cognitive impairment, falls, confusion, dry mouth and constipation. Therefore, FGAs have been classified as ‘potentially inappropriate’ for use in older patients by the American Geriatrics Society. It has also been shown that dermatologists do not always take patient characteristics (e.g. age or life expectancy) into account when deciding on a treatment, instead following a ‘one‐size‐fits‐all’ approach. What does this study add? FGAs are often prescribed during dermatology visits, and prescription rates do not differ between older and younger patients. There were no significant differences in prescription rates when comparing younger and older adults with the same diagnosis or symptom (e.g. dermatitis, pruritus or itch). FGAs are prescribed at higher rates in primary‐care offices than in dermatology offices.

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Section: Discussionsupporting

confidence: 89%

Section: Methodsmentioning

confidence: 99%

A multiyear cross‐sectional study of U.S. national prescribing patterns of first‐generation sedating antihistamines in older adults with skin disease

et al. 2019

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“…5 Besides these clinical indicator variables, I included patient age (65-74, 75-84, or 85+), gender, race/ethnicity (non-Hispanic whites, non-Hispanic blacks, Hispanics, or other) and physician specialty (primary care, psychiatry, or other). 6,7 …”

Section: Methodsmentioning

confidence: 99%

Continuing versus new antidepressant use in older adults: US prescribing trends from 2006 to 2015

Rhee

2018

Eur Geriatr Med

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Objectives Antidepressant use has increased in older adults recently. This study examines the trends of antidepressant prescribing by prescription status (continuing vs. new prescriptions). Methods Data were collected from 2006-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based outpatient visits. I limited the sample to adults aged 65 or older (n=10,708 unweighted). Using a repeated cross-sectional design with survey sampling techniques, prevalence rates of antidepressant prescriptions were estimated by prescription status. Stratified analyses were also performed by key variables (e.g., age, gender, and race/ethnicity). Results Continuing antidepressant prescriptions increased over time significantly (OR=1.07; 95% CI, 1.03-1.11), and no temporal trend was found in new antidepressant prescriptions. In stratified analyses, the increasing trends of continuing antidepressant prescriptions were pronounced in visits to primary care physicians (OR=1.06; 95% CI, 1.01-1.12). Conclusion Increasing antidepressant prescribing trends were found in continuing prescriptions. Continued antidepressant prescribing among older adults should be monitored for appropriate use.

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“…The NAMCS collected up to eight medications prescribed in 2006‐2011, up to 10 medications in 2012‐2013, and up to 30 medications in 2014‐2015. We examined the first eight medications listed as prescribed for each visit, ensuring consistency across years . For each medication, there is a status indicator variable whether the prescribed medication is newly prescribed at that visit, continued from previous visits, or unknown.…”

Section: Methodsmentioning

confidence: 99%

Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015

Rhee

Rosenheck

2018

Health Services Research

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Objectives To estimate rates and national trends of initiation of new psychotropic medications without a psychiatric diagnosis and to identify demographic and clinical correlates independently associated with such use among US adults in outpatient settings. Data Source Data were gathered from the 2006‐2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office‐based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n = 8618 unweighted). Study Design Using a repeated cross‐sectional design with survey sampling techniques, we estimated prescription initiation rates and national trends. Multivariable‐adjusted logistic regression analysis was used to identify correlates independently associated with initiation of new psychotropic prescriptions without a psychiatric diagnosis. Data Collection/Extraction Methods Data were publicly available, and we extracted them from the Centers for Disease Control and Prevention website. Principal Findings Altogether, at 60.4% of visits at which a new psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 59.1% in 2006‐2007 to 67.7% in 2008‐2009 and then decreased to 52.0% in 2014‐2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits (OR = 0.02; 95% CI, 0.01‐0.04). Visits to non‐psychiatric specialists showed 6.90 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI, 5.38‐8.86). Conclusion New psychotropic medications are commonly initiated without any psychiatric diagnosis, especially by non‐psychiatrist physicians. Non‐psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.

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National Prescribing Trends for High‐Risk Anticholinergic Medications in Older Adults

Cited by 35 publications

References 19 publications

A multiyear cross‐sectional study of U.S. national prescribing patterns of first‐generation sedating antihistamines in older adults with skin disease

A multiyear cross‐sectional study of U.S. national prescribing patterns of first‐generation sedating antihistamines in older adults with skin disease

Continuing versus new antidepressant use in older adults: US prescribing trends from 2006 to 2015

Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015

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