Abstract
IntroductionPolicy 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.MethodsWe 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 65 years 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.ResultsPrescribing 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.ConclusionsIncreased surveillance and evaluation of drug safety warnings and guidance are needed to improve the impact of future interventions.Electronic supplementary materialThe online version of this article (doi:10.1007/s40264-017-0538-x) contains supplementary material, which is available to authorized users.
Highlights
Introduction Policy interventions to address inappropriate prescribing of antipsychotic drugs to older people diagnosed with dementia are commonplace
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
Summary
Regulatory bodies in several countries have issued warnings, guidance and advice aiming to reduce inappropriate prescribing of antipsychotic drugs to patients diagnosed with dementia [10,11,12,13,14,15,16,17,18,19,20,21]. It is important to evaluate the impact, and compare the methods of dissemination, of such interventions to inform future policy to reduce antipsychotic drug prescribing to patients with dementia as well as provide useful lessons on implementing national guidance and warnings. Guidelines published by the National Institute for Health and Care Excellence (NICE) in November 2006 recommended that antipsychotic drugs should not be prescribed for patients who experience behavioural and psychological symptoms of dementia of mild-to-moderate severity because of the increased risk of cerebrovascular adverse effects. The approach to the implementation of NICE guidance varies between National Health Service organisations
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