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

Stocks, S. Jill; Kontopantelis, Evangelos; Webb, Roger T.; Avery, Anthony J.; Burns, Alistair; Ashcroft, Darren M.

Abstract

© 2017, The Author(s). 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 in 2004, 2009 and 2012 and the National Institute for Health and Care Excellence guidance was published in 2006. It is important to evaluate the impact of such interventions. Methods: We analysed routinely collected primary-care data from 111,346 patients attending one of 689 general practices contributing to the Clinical Practice Research Datalink to describe the temporal changes in the prescribing of antipsychotic drugs to patients aged 65years or over diagnosed with dementia without a concomitant psychosis diagnosis from 2001 to 2014 using an interrupted time series and a before-and-after design. Logistic regression methods were used to quantify the impact of patient and practice level variables on prescribing prevalence. Results: Prescribing of first-generation antipsychotic drugs reduced from 8.9% in 2001 to 1.4% in 2014 (prevalence ratio 2014/2001 adjusted for age, sex and clustering within practices (0.14, 95% confidence interval 0.12–0.16), whereas there was little change for second-generation antipsychotic drugs (1.01, confidence interval 0.94–1.17). Between 2004 and 2012, several policy interventions coincided with a pattern of ups and downs, whereas the 2006 National Institute for Health and Care Excellence guidance was followed by a gradual longer term reduction. Since 2013, the decreasing trend in second-generation antipsychotic drug prescribing has plateaued largely driven by the increasing prescribing of risperidone. Conclusions: Increased surveillance and evaluation of drug safety warnings and guidance are needed to improve the impact of future interventions.

Citation

Stocks, S. J., Kontopantelis, E., Webb, R. T., Avery, A. J., Burns, A., & Ashcroft, D. M. (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, 40(8), 679-692. https://doi.org/10.1007/s40264-017-0538-x

• Journal Article Type: Article
• Acceptance Date: Apr 11, 2017
• Online Publication Date: Apr 24, 2017
• Publication Date: Apr 24, 2017
• Deposit Date: May 2, 2017
• Publicly Available Date: May 2, 2017
• Journal: Drug Safety
• Print ISSN: 0114-5916
• Electronic ISSN: 1179-1942
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 40
• Issue: 8
• Pages: 679-692
• DOI: https://doi.org/10.1007/s40264-017-0538-x
• Keywords: Antipsychotic Prescribing; Dementia; Psychosis; National Guidance and Drug Safety Warnings; General Practice
• Public URL: https://nottingham-repository.worktribe.com/output/857239
• Publisher URL: http://link.springer.com/article/10.1007%2Fs40264-017-0538-x
• Related Public URLs: https://creativecommons.org/licenses/by-nc/4.0/
• Additional Information: First Online: 24 April 2017; : ; : This study was funded by the National Institute for Health Research (ExternalRef removed) through the Greater Manchester Primary Care Patient Safety Translational Research Centre, Grant No. gmpstrc-2012-1. The Medical Research Council Health eResearch Centre Grant MR/K006665/1 supported the time and facilities of one investigator (EK). The views expressed are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research, the Medical Research Council or the Department of Health. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.; : S Jill Stocks, Evangelos Kontopantelis, Roger T. Webb, Anthony J. Avery, Alistair Burns and Darren M. Ashcroft have no conflicts of interest that are directly relevant to the content of this study.; : The study was approved by the Independent Scientific Advisory Committee for Clinical Practice Research Datalink research (Reference No. 16_054). No further ethics approval was required for the analysis of the data.
• Contract Date: May 2, 2017