Psychotropic Medicine Utilization in Older People in New Zealand from 2005 to 2013

Ndukwe, Henry C.; Tordoff, June; Wang, Ting; Nishtala, Prasad S.

doi:10.1007/s40266-014-0205-1

Cited by 20 publications

(16 citation statements)

References 50 publications

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“…Pharms database is a National utilization claims database maintained by the MoH that captures all community pharmacies dispensings in New Zealand, whereas the NMDS database holds a collection of hospital-related events and diagnosis (Ndukwe et al, 2014;Nishtala et al, 2014). The ChEI and β-blockers were categorized using the Anatomic, Therapeutic and Chemical (ATC) classification developed by the World Health Organisation Collaborating Centre for Drug Statistics Methodology's Anatomical Therapeutic and Chemical (WHOCC) classification (WHOCC, 2014).…”

Section: Data Sourcementioning

confidence: 99%

Temporal trends for donepezil utilization among older people

Ndukwe

Nishtala

2016

International Clinical Psychopharmacology

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To examine and characterize overall donepezil and concomitant utilization with β-blockers, yearly, in older New Zealanders. Deidentified data from the Pharmaceutical claims database and the National Minimum Dataset were obtained for 2011 to 2013 from the Ministry of Health. Population-level data were extracted for donepezil and β-blockers utilization, measured by defined daily dose (DDD) per thousand older people per day (TOPD). Donepezil utilization increased from 5.2 to 8.2 DDD/TOPD between 2011 and 2013. In 2011, the number of prevalent users was 4634, the mean age was 79.4±6.6 years and 57.5% were women. Highest use by age for donepezil was in those aged 85 years or older (2.3 DDD/TOPD), followed by those aged 80-84 years (2.2 DDD/TOPD). The mean utilization volumes were significantly lower for donepezil 5 mg (Student t-test=9.86; P<0.05) and 10 mg (10.90; P<0.05) in the 65- to 69-year age group compared with the 80- to 84-year age group, whereas the proportion of concomitant utilization of donepezil with β-blockers decreased (17.9% to 5.1%). Donepezil utilization in DDD/TOPD increased by three-fifths between 2011 and 2013. Prescribers appear to be aware of the potential risk of bradycardia with the concomitant use of donepezil and β-blockers.

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Section: Data Sourcementioning

confidence: 99%

Temporal trends for donepezil utilization among older people

Ndukwe

Nishtala

2016

International Clinical Psychopharmacology

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“…De‐identified utilisation claims data for all individuals aged 65 years and above for the period 2005 to 2013 were obtained from the New Zealand Ministry of Health (MoH). Individual‐level dispensing data were extracted from the Pharms database, a national pharmaceutical claims database maintained by the MoH which captures almost all subsidised pharmaceutical dispensings by community pharmacies in New Zealand . The utilisation of psychotropic drugs within an individual in a health board domicile was the consideration for this study.…”

Section: Methodsmentioning

confidence: 99%

“…Sampling was not employed because population‐level data sourced from MoH were representative of the older population in New Zealand. Previously, we published findings on the same population and had established that the data sourced from MoH were 95% representative of older people in New Zealand when compared to census data . Psychotropic drug utilisation rates were unadjusted for differential morbidity rates or differences in equity of access.…”

Section: Methodsmentioning

confidence: 99%

“…The database was normalised for yearly raw counts by sex, age group, ethnicity, deprivation status and therapeutic class. Psychotropic utilisation in DDD was calculated using the equation stated in our previous study . Subsequently, drug volumes for each health board may then be computed using Eqn below:

\begin{matrix} \sum_{i = 1}^{normaln} DDDi / DOPY = & DDD sum / \\ health board older population . \end{matrix}

…”

Section: Methodsmentioning

confidence: 99%

“…Exploring predictors of psychotropic utilisation, especially from population studies, may inform prescribers, patients and health policy experts about the rational use of psychotropic drugs. Prior studies have shown that regional utilisation of psychotropic drugs varied by population characteristics, health systems, prescriber behaviour, the number or severity of mental illnesses, subsidy, and social or environmental factors .…”

Section: Introductionmentioning

confidence: 99%

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Geographic variation in psychotropic drug utilisation among older people in New Zealand

et al. 2016

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Association of Focused Medication Review With Optimization of Psychotropic Drug Prescribing

et al. 2018

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Importance Medication review has been proposed to achieve improved use of psychotropic drugs, but benefits have not been confirmed. Objective To synthesize evidence for focused psychotropic medication review in medication optimization. Data Sources Medline, PsycINFO, EMBASE, and CINAHL Plus were searched from inception to February 2018 using the index terms “drug utilization review” and “psychotropic drugs” and synonyms. Additional articles were retrieved using citation tracking and reference checking. Study Selection Full-length, peer-reviewed articles that reported focused psychotropic medication review were included. Inclusion was determined against prespecified criteria and assessed independently. Data Extraction and Synthesis Study quality was assessed using National Institutes for Health appraisal tools and informed a structured synthesis of results. Meta-analysis using a random effects model was conducted. Main Outcomes and Measures Change in the number or dosage of psychotropic medications, change in clinical parameters, change in patient-reported outcomes, and economic data were collected. Results A total of 26 studies met the inclusion criteria. Four studies were randomized clinical trials (n = 712 participants), while the remainder were before-after studies (n = 7844 participants). Most studies were conducted in elderly individuals, people with dementia, and adults with intellectual disability. Focused psychotropic medication review is a complex intervention; the professional(s) involved, target drug, degree of integration with usual care, and participant involvement varied greatly among the studies. Meta-analysis included 3 studies (n = 652 participants). Psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs compared with control (pooled odds ratio, 0.24; 95% CI, 0.14-0.39) in elderly participants with cognitive impairment living in nursing homes. Before-after studies consistently reported a change in psychotropic drug prescribing after medication review, regardless of the population. Studies that reported the effects of psychotropic medication review on clinical outcomes failed to demonstrate benefit. Economic implications of focused psychotropic medication review were not adequately assessed. The quality of evidence is poor and studies are at risk of bias. Conclusions and Relevance Focused psychotropic medication review was associated with a reduction in prescribing of psychotropic drugs, but has not been shown to improve clinical outcomes or to provide economic benefit. More robust evidence is needed before programs of focused psychotropic medication review can be recommended as part of routine care for any patient group.

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Psychotropic Medicine Utilization in Older People in New Zealand from 2005 to 2013

Cited by 20 publications

References 50 publications

Temporal trends for donepezil utilization among older people

Temporal trends for donepezil utilization among older people

Geographic variation in psychotropic drug utilisation among older people in New Zealand

Association of Focused Medication Review With Optimization of Psychotropic Drug Prescribing

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