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Research article:

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

Reference:

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:

Link to article
Abstract
Introduction 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. Methods 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. Results 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%). Conclusions The prevalence of prescribing second-generation antipsychotics to older people with dementia is increasing. These results may inform future policy interventions.
Author for correspondence
Jill Stocks
Email for correspondence
jill.stocks@manchester.ac.uk

Code list: res53: P13_dementia

96 codes in list

Code Coding system Description Entity type List name
A411.00 Read Jakob-Creutzfeldt disease diagnostic res53: P13_dementia
E00..00 Read Senile and presenile organic psychotic conditions diagnostic res53: P13_dementia
E000.00 Read Uncomplicated senile dementia diagnostic res53: P13_dementia
E001.00 Read Presenile dementia diagnostic res53: P13_dementia
E001000 Read Uncomplicated presenile dementia diagnostic res53: P13_dementia
E00..11 Read Senile dementia diagnostic res53: P13_dementia
E001100 Read Presenile dementia with delirium diagnostic res53: P13_dementia
E00..12 Read Senile/presenile dementia diagnostic res53: P13_dementia
E001200 Read Presenile dementia with paranoia diagnostic res53: P13_dementia
E001300 Read Presenile dementia with depression diagnostic res53: P13_dementia
E001z00 Read Presenile dementia NOS diagnostic res53: P13_dementia
E002.00 Read Senile dementia with depressive or paranoid features diagnostic res53: P13_dementia
E002000 Read Senile dementia with paranoia diagnostic res53: P13_dementia
E002100 Read Senile dementia with depression diagnostic res53: P13_dementia
E002z00 Read Senile dementia with depressive or paranoid features NOS diagnostic res53: P13_dementia
E003.00 Read Senile dementia with delirium diagnostic res53: P13_dementia
E004.00 Read Arteriosclerotic dementia diagnostic res53: P13_dementia
E004000 Read Uncomplicated arteriosclerotic dementia diagnostic res53: P13_dementia
E004100 Read Arteriosclerotic dementia with delirium diagnostic res53: P13_dementia
E004.11 Read Multi infarct dementia diagnostic res53: P13_dementia
E004200 Read Arteriosclerotic dementia with paranoia diagnostic res53: P13_dementia
E004300 Read Arteriosclerotic dementia with depression diagnostic res53: P13_dementia
E004z00 Read Arteriosclerotic dementia NOS diagnostic res53: P13_dementia
E00y.00 Read Other senile and presenile organic psychoses diagnostic res53: P13_dementia
E00y.11 Read Presbyophrenic psychosis diagnostic res53: P13_dementia
E00z.00 Read Senile or presenile psychoses NOS diagnostic res53: P13_dementia
E012.00 Read Other alcoholic dementia diagnostic res53: P13_dementia
E012000 Read Chronic alcoholic brain syndrome diagnostic res53: P13_dementia
E012.11 Read Alcoholic dementia NOS diagnostic res53: P13_dementia
E02y100 Read Drug-induced dementia diagnostic res53: P13_dementia
E041.00 Read Dementia in conditions EC diagnostic res53: P13_dementia
Eu00.00 Read [X]Dementia in Alzheimer's disease diagnostic res53: P13_dementia
Eu00000 Read [X]Dementia in Alzheimer's disease with early onset diagnostic res53: P13_dementia
Eu00011 Read [X]Presenile dementia,Alzheimer's type diagnostic res53: P13_dementia
Eu00012 Read [X]Primary degen dementia, Alzheimer's type, presenile onset diagnostic res53: P13_dementia
Eu00013 Read [X]Alzheimer's disease type 2 diagnostic res53: P13_dementia
Eu00100 Read [X]Dementia in Alzheimer's disease with late onset diagnostic res53: P13_dementia
Eu00111 Read [X]Alzheimer's disease type 1 diagnostic res53: P13_dementia
Eu00112 Read [X]Senile dementia,Alzheimer's type diagnostic res53: P13_dementia
Eu00113 Read [X]Primary degen dementia of Alzheimer's type, senile onset diagnostic res53: P13_dementia
Eu00200 Read [X]Dementia in Alzheimer's dis, atypical or mixed type diagnostic res53: P13_dementia
Eu00z00 Read [X]Dementia in Alzheimer's disease, unspecified diagnostic res53: P13_dementia
Eu00z11 Read [X]Alzheimer's dementia unspec diagnostic res53: P13_dementia
Eu01.00 Read [X]Vascular dementia diagnostic res53: P13_dementia
Eu01000 Read [X]Vascular dementia of acute onset diagnostic res53: P13_dementia
Eu01100 Read [X]Multi-infarct dementia diagnostic res53: P13_dementia
Eu01.11 Read [X]Arteriosclerotic dementia diagnostic res53: P13_dementia
Eu01111 Read [X]Predominantly cortical dementia diagnostic res53: P13_dementia
Eu01200 Read [X]Subcortical vascular dementia diagnostic res53: P13_dementia
Eu01300 Read [X]Mixed cortical and subcortical vascular dementia diagnostic res53: P13_dementia
Eu01y00 Read [X]Other vascular dementia diagnostic res53: P13_dementia
Eu01z00 Read [X]Vascular dementia, unspecified diagnostic res53: P13_dementia
Eu02.00 Read [X]Dementia in other diseases classified elsewhere diagnostic res53: P13_dementia
Eu02000 Read [X]Dementia in Pick's disease diagnostic res53: P13_dementia
Eu02100 Read [X]Dementia in Creutzfeldt-Jakob disease diagnostic res53: P13_dementia
Eu02200 Read [X]Dementia in Huntington's disease diagnostic res53: P13_dementia
Eu02300 Read [X]Dementia in Parkinson's disease diagnostic res53: P13_dementia
Eu02400 Read [X]Dementia in human immunodef virus [HIV] disease diagnostic res53: P13_dementia
Eu02500 Read [X]Lewy body dementia diagnostic res53: P13_dementia
Eu02y00 Read [X]Dementia in other specified diseases classif elsewhere diagnostic res53: P13_dementia
Eu02z00 Read [X] Unspecified dementia diagnostic res53: P13_dementia
Eu02z11 Read [X] Presenile dementia NOS diagnostic res53: P13_dementia
Eu02z12 Read [X] Presenile psychosis NOS diagnostic res53: P13_dementia
Eu02z13 Read [X] Primary degenerative dementia NOS diagnostic res53: P13_dementia
Eu02z14 Read [X] Senile dementia NOS diagnostic res53: P13_dementia
Eu02z15 Read [X] Senile psychosis NOS diagnostic res53: P13_dementia
Eu02z16 Read [X] Senile dementia, depressed or paranoid type diagnostic res53: P13_dementia
Eu04100 Read [X]Delirium superimposed on dementia diagnostic res53: P13_dementia
Eu05700 Read [X]Mild cognitive disorder diagnostic res53: P13_dementia
F110.00 Read Alzheimer's disease diagnostic res53: P13_dementia
F110000 Read Alzheimer's disease with early onset diagnostic res53: P13_dementia
F110100 Read Alzheimer's disease with late onset diagnostic res53: P13_dementia
F111.00 Read Pick's disease diagnostic res53: P13_dementia
F1110A Read diagnostic res53: P13_dementia
F112.00 Read Senile degeneration of brain diagnostic res53: P13_dementia
F116.00 Read Lewy body disease diagnostic res53: P13_dementia
F118.00 Read diagnostic res53: P13_dementia
F11x.00 Read Cerebral degeneration in other disease EC diagnostic res53: P13_dementia
F11x000 Read Cerebral degeneration due to alcoholism diagnostic res53: P13_dementia
F11x011 Read Alcoholic encephalopathy diagnostic res53: P13_dementia
F11x200 Read Cerebral degeneration due to cerebrovascular disease diagnostic res53: P13_dementia
F11x400 Read Cerebral degeneration due to neoplastic disease diagnostic res53: P13_dementia
F11x500 Read Cerebral degeneration due to myxoedema diagnostic res53: P13_dementia
F11x600 Read Cerebral degeneration due to vitamin B12 deficiency diagnostic res53: P13_dementia
F11x700 Read Cerebral degeneration due to Jakob - Creutzfeldt disease diagnostic res53: P13_dementia
F11x800 Read Cerebral degeneration due to multifocal leucoencephalopathy diagnostic res53: P13_dementia
F11x900 Read Cerebral degeneration in Parkinson's disease diagnostic res53: P13_dementia
F11xz00 Read Cerebral degeneration other disease NOS diagnostic res53: P13_dementia
F11y.00 Read Other cerebral degeneration diagnostic res53: P13_dementia
F11y000 Read Reye's syndrome diagnostic res53: P13_dementia
F11y100 Read Cerebral ataxia diagnostic res53: P13_dementia
F11yz00 Read Other cerebral degeneration NOS diagnostic res53: P13_dementia
F11z.00 Read Cerebral degeneration NOS diagnostic res53: P13_dementia
F11z.11 Read Cerebral atrophy diagnostic res53: P13_dementia
F134.00 Read Huntington's chorea diagnostic res53: P13_dementia
Fyu3000 Read [X]Other Alzheimer's disease diagnostic res53: P13_dementia

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