Antipsychotic prescribing to patients diagnosed with dementia without a diagnosis of psychosis in the context of national guidance and drug safety warnings: longitudinal study in UK general practice
S Jill Stocks, Evangelos Kontopantelis, Roger T Webb, Anthony J Avery, Alistair Burns, Darren M Ashcroft(2017)
Antipsychotic prescribing to patients diagnosed with dementia without a diagnosis of psychosis in the context of national guidance and drug safety warnings: longitudinal study in UK general practice.
Drug Safety, doi:
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Policy interventions to address inappropriate prescribing of antipsychotic drugs to older people diagnosed with dementia are commonplace. In the UK warnings were issued by the Medicines Healthcare products Regulatory Agency (MHRA) in 2004, 2009 and 2012 and National Institute for Health and Care Excellence (NICE) guidance was published in 2006. It is important to evaluate the impact of such interventions.
We analysed routinely-collected primary-care data from 112,384 patients attending one of 689 general practices contributing to the Clinical Practice Research Datalink to describe the temporal changes in prescribing of antipsychotic drugs to patients aged 65 years or over diagnosed with dementia without a concomitant psychosis diagnosis from 2001 to 2014 using an interrupted time series design. Logistic regression methods were used to quantify the impact of patient and practice level variables on prescribing prevalence and the variation between practices.
The MHRA warning in 2004 was temporally associated with a marked, albeit short term, reduction in prescribing of antipsychotics whereas NICE guidance may have had longer term impact. There was switching between specific drugs in response to some interventions. Prescribing of second generation antipsychotics was similar in 2014 and 2001 (prevalence ratio 2014/2001 (PR) adjusted for age, gender and clustering within practices 0.96, 95% CI 0.85 to 1.08) whereas prescribing of first-generation antipsychotics reduced from 6.6% to 1.2% (PR 0.13, 0.11 to 0.15). There was a wide variation in prescribing between general practices (prediction intervals 1.3% to 16.7%).
The prevalence of prescribing second-generation antipsychotics to older people with dementia is increasing. These results may inform future policy interventions.
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- Jill Stocks
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