Trends in Central Nervous System–Active Polypharmacy Among Older Adults Seen in Outpatient Care in the United States

Maust, Donovan T.; Gerlach, Lauren B.; Gibson, Anastasia; Kales, Helen C.; Blow, Frederic C.; Olfson, Mark

doi:10.1001/jamainternmed.2016.9225

Cited by 47 publications

(55 citation statements)

References 4 publications

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“…Co‐prescribing three or more drugs acting on the CNS was also associated with factors related to inappropriate drug use in older adults. Data from the USA show that age, female sex, anxiety, depression and insomnia are major factors . Unlike the other two types of PHDI, however, the risk was greater in those living in cities.…”

Section: Discussionmentioning

confidence: 97%

“…As depression and anxiety are more common in urban than rural areas, it can be inferred that older adults living in urban areas had greater challenges in mental health and were therefore co‐prescribed three or more drugs acting on the CNS more often than those in rural areas . However, data from the USA show that the rate of co‐prescription of three or more drugs is higher in rural areas than in cities . Further studies regarding this discrepancy are warranted.…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with potentially harmful drug–drug interactions in older Korean people: A population‐based study

Yoon

Kim

Jung

et al. 2018

Geriatrics Gerontology Int

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The findings of the present study highlight the three most frequent PHDI in Korea according to the Beers Criteria 2015. Healthcare providers should take PHDI into account when treating female patients, medical aid beneficiaries, patients using multiple healthcare institutions, frequent outpatient visitors and patients prescribed more than six medications in a single prescription. Geriatr Gerontol Int 2018; 18: 1378-1382.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Factors associated with potentially harmful drug–drug interactions in older Korean people: A population‐based study

Yoon

Kim

Jung

et al. 2018

Geriatrics Gerontology Int

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“…10 Rates reported in this study are higher because I focused on older adults, who tended to report higher prevalence rates of long-term antidepressant use than their younger counterparts in previous studies. 2,10 Furthermore, the increased prescribing patterns were mostly evident from 2006-2007 to 2008-2009. This pattern may be related to the expansion of Medicare Part D: Prescription Drug Plans coverage, which was initiated in 2006 and successfully implemented over time.…”

Section: Discussionmentioning

confidence: 98%

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%

“…We examined the first eight medications listed as prescribed for each visit, ensuring consistency across years. 3,[20][21][22] 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. We considered new prescribed psychotropic medications to represent the "initiation" of psychotropic treatment at the visit in question.…”

Section: Psychotropic Medicationsmentioning

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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Trends in Central Nervous System–Active Polypharmacy Among Older Adults Seen in Outpatient Care in the United States

Cited by 47 publications

References 4 publications

Factors associated with potentially harmful drug–drug interactions in older Korean people: A population‐based study

Factors associated with potentially harmful drug–drug interactions in older Korean people: A population‐based study

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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