Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia

BMC Health Services Research

Helga Zoega¹  Jonathan Brett¹  Benjamin J. Daniels¹  Sallie-Anne Pearson¹  Adam G. Elshaug²  Nicholas A. Buckley³ 

[1] Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales;Menzies Centre for Health Policy, The University of Sydney;School of Medicine, The University of Sydney;

关键词: Elderly;    Benzodiazepines;    Antipsychotics;    Dementia;    Polypharmacy;    Choosing wisely;   

DOI  :  10.1186/s12913-018-3811-5

来源: DOAJ

【 摘 要 】

Abstract Background The global Choosing Wisely campaign has identified the following psychotropic prescribing as low-value (harmful or wasteful): (1) benzodiazepine use in the elderly, (2) antipsychotic use in dementia and (3) prescribing two or more antipsychotics concurrently. We aimed to quantify the extent of these prescribing practices in the Australian population. Methods We applied indicators to dispensing claims of a 10% random sample of Australian Pharmaceutical Benefits Scheme beneficiaries to quantify annual rates of each low-value practice from 2013 to 2016. We also assessed patient factors and direct medicine costs (extrapolated to the entire Australian population) associated with each practice in 2016. Results We observed little change in the rates of the three practices between 2013 and 2016. In 2016, 15.3% of people aged ≥65 years were prescribed a benzodiazepine, 0.5% were prescribed antipsychotics in the context of dementia and 0.2% of people aged ≥18 years received two or more antipsychotics concurrently. The likelihood of elderly people receiving benzodiazepines or antipsychotics in the context of dementia increased with age and the likelihood of receiving all three practices increased with comorbidity burden. In 2016, direct medicine costs to the government of all three practices combined, extrapolated to national figures, were > $21 million AUD. Conclusions Our indicators suggest that the frequency of these three practices has not changed appreciably in recent years and that they incur significant costs. Worryingly, people with the greatest risk of harm from these prescribing practices are often the most likely to receive them.

【 授权许可】

Unknown