When Direct Health-Care Professional Communications Have an Impact on Inappropriate and Unsafe Use of Medicines

Reber, K.; Piening, Sigrid; Wieringa, Jaap E.; Straus, Sabine M. J. M.; Raine, June; Graeff, de Pieter; Haaijer‐Ruskamp, Flora; Mol, Peter G. M.

doi:10.1038/clpt.2012.262

Cited by 34 publications

(36 citation statements)

References 20 publications

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“…Second, the way health care providers received the warning could explain their lack of long-term efficacy. For instance, a study described that professional recommendations on drugs have less impact on specialists compared with nonspecialists [45]. This hypothesis should be considered because this study took place in a specialized setting.…”

Section: Discussionmentioning

confidence: 99%

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Tifratene

Manera²,

Fabre

et al. 2017

Alz Res Therapy

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BackgroundSafety warnings from health authorities are currently intended to limit the use of antipsychotics (APs) in dementia-related conditions to treat neuropsychiatric symptoms, such as disturbing and/or delusional behaviors. The aim of this study is to investigate prevalence, correlates and trends of AP prescribing among people with dementia between 2010 and 2014 in the French population.MethodsAP prescribing and associated factors among individuals with AD, mixed dementia and vascular dementia in the French National Alzheimer Database between 2010 and 2014 were analyzed using multivariate generalized estimating equations models (n = 199,549).ResultsIn 2014, 7.7% of people with dementia were prescribed an AP. Compared with 2010 there was a 16% increase in AP use. Multivariate analysis showed a linear increase risk of prescription with an adjusted odds ratio (95% confidence interval) of 1.23 (1.17–1.30) in 2014 compared with 2010. Factors associated with AP prescribing were male gender, more severe cognitive decline and living in long-term care facilities. Older age and higher education were protective toward AP prescribing. The type of dementia did not have any influence on AP prescribing.ConclusionAn increase in AP prescribing among individuals with dementia in French specialized settings over the last 5 years occurred despite safety warnings. This phenomenon suggests that alternative solutions for the management of behavioral and psychiatric symptoms in these populations are still urgently needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-017-0256-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Tifratene

Manera²,

Fabre

et al. 2017

Alz Res Therapy

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“…Response to safety warnings is mixed depending on the drug, condition it treats, the nature of the risks and the treatment setting (Dusetzina et al, 2012; Reber et al, 2013). Prior analyses would have predicted the antipsychotic warning to have a significant effect on prescribing because antipsychotics are mainly prescribed by general practitioners in France (Lecadet et al, 2003; Martin et al, 2004), who tend to be more responsive to warnings, and because there was an increased risk of death (Reber et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…Prior analyses would have predicted the antipsychotic warning to have a significant effect on prescribing because antipsychotics are mainly prescribed by general practitioners in France (Lecadet et al, 2003; Martin et al, 2004), who tend to be more responsive to warnings, and because there was an increased risk of death (Reber et al, 2013). Yet, like suggested in Germany (Schulze et al, 2013), the safety warnings in France did not seem to have an impact on antipsychotic prescribing.…”

Section: Discussionmentioning

confidence: 99%

Trends in use of antipsychotics in elderly patients with dementia: Impact of national safety warnings

Gallini

Andrieu

Donohue

et al. 2014

European Neuropsychopharmacology

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Based on evidence of an increased risk of death, drug agencies issued safety warnings about the use of second generation antipsychotics (SGAs) in the elderly with dementia in 2004. This warning was extended to all antipsychotics in 2008. Little is known about the impact of these warnings on use. We conducted a quasi-experimental study (interrupted time-series) in France, for 2003–2011, including subjects aged ≥65 with dementia and subjects aged ≥65 without dementia in the EGB database (1/97th representative random sample of claims from the main Health Insurance scheme). Outcomes were monthly rates of use of antipsychotics (by class and agent) and of 5 comparison drug classes (antidepressants, benzodiazepines, dermatologicals, antidiabetics, antiasthmatics). Trends were analyzed by joinpoint regression, impact of warnings by linear segmented regression. In patients with dementia (n=7169), there was a 40% reduction in antipsychotic use from 14.2% in 2003 to 10.2% in 2011. The reduction began before 2004 and was unaffected by the warnings. Use of first generation antipsychotics declined over the period, while use of SGAs increased and leveled off from 2007. Use of the 5 comparison drug classes increased on the period. In subjects without dementia (n=91942), rates of overall antipsychotic use decreased from 2.3% in 2003 to 1.8% in 2011 with no effect of the warnings. Meanwhile, use of SGAs continuously increased from 0.37% to 0.64%. Antipsychotic use decreased in the elderly between 2003 and 2011, especially in dementia. The timing of the decrease, however, did not coincide with safety warnings.

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“…New use is known to be a more sensitive measure than overall use, because changes in prescribing behavior are more likely with new users (Reber et al. 2013). We limited our statistical analysis of demographic characteristics and use of GP drugs (Table 1) to clinically relevant parameters: age, gender, and percentage of patients without GP drugs at the start of clopidogrel.…”

Section: Discussionmentioning

confidence: 99%

Prescription behavior for gastroprotective drugs in new users as a result of communications regarding clopidogrel – proton pump inhibitor interaction

Kruik-Kollöffel

Palen

Kruik

et al. 2016

Pharmacology Res & Perspec

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Safety concerns of the concomitant use of clopidogrel and proton pump inhibitors (PPIs) were published in 2009 and 2010 by the medicines regulatory agencies, including a direct healthcare professional communication. We examined the association between various safety statements and prescription behavior for gastroprotective drugs in naïve patients in the Netherlands during the years 2008–2011. Data from the PHARMO Database Network were analyzed with interrupted time series analyses to estimate the impact of each communication on drug prescriptions. Dispensings were used as a proxy variable for prescription behavior. After the early communication in January 2009, 15.5% (95% CI 7.8, 23.4) more patients started concomitantly with (es)omeprazole and 13.8% (95% CI 6.5, 21.2) less with other PPIs. Directly after the first statement in June 2009, we found a steep increase in histamine 2‐receptor antagonists (H2RA) peaking at 25%, placing those patients at risk for gastrointestinal events. This effect for H2RA faded away after a few months. In February 2010, when the official advice via an adjusted statement was to avoid (es)omeprazole, we found a decrease of 11.9% (95% CI 5.7, 18.2) for (es)omeprazole and an increase of +16.0% (95% CI 10.3, 21.7) for other PPIs. Still 22.6% (95% CI 19.5, 25.7) of patients started on (es)omeprazole in February 2010, placing them at risk for cardiovascular events. Advices of regulatory authorities were followed, however, reluctantly and not fully, probably partly because of the existing scientific doubt about the interaction.

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When Direct Health-Care Professional Communications Have an Impact on Inappropriate and Unsafe Use of Medicines

Cited by 34 publications

References 20 publications

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Trends in use of antipsychotics in elderly patients with dementia: Impact of national safety warnings

Prescription behavior for gastroprotective drugs in new users as a result of communications regarding clopidogrel – proton pump inhibitor interaction

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