Abstract
Tricyclic antidepressants are known as potentially inappropriate medications in the elderly. A notification issued in July 2015 in South Korea recommended caution while prescribing tricyclic antidepressants to the elderly. Further, since October 2015, the nationwide computerized drug utilization review monitoring system provides a pop-up window, on a real-time basis, whenever tricyclic antidepressants are prescribed to elderly outpatients. Therefore, we evaluated whether providing drug utilization review information was effective in reducing tricyclic antidepressant prescription to elderly outpatients. We used the Health Insurance Review and Assessment Service-Adult Patient Sample data from 2014 to 2016. Data related to the prescription of tricyclic antidepressants to outpatients aged 65 years or more were extracted. We determined the number of prescriptions per day per 100,000 elderly patients in each month, compared the average number of prescriptions before and after the drug utilization review information was provided, and evaluated the changes in the number of prescriptions by using an interrupted time series analysis. The average number of tricyclic antidepressant prescriptions per day per 100,000 elderly patients decreased from 76.6 (75.5 to 77.6) to 65.7 (64.5 to 66.9), a 14.2% reduction after the provision of drug utilization review information started. Following initiation of provision of drug utilization review information, there was an immediate drop of 9.2 tricyclic antidepressant prescriptions per day per 100,000 elderly patients, whereas there was no statistically significant change in trends. Providing the drug utilization review information on tricyclic antidepressant prescription for the elderly contributed to the reduction in tricyclic antidepressant prescriptions.
Highlights
The World Health Organization has reported that depression contributes greatly to the worldwide disease burden: depression was the third leading contributor in 2004 and is predicted to be the leading contributor by 2030 [1]
Tricyclic antidepressants (TCAs) prescriptions continued to decline after the provision of drug utilization review (DUR) information was started until January 2016; thereafter, it remained relatively steady until the end of 2016
After the provision of DUR information started, there was an immediate drop of 9.2 TCA prescriptions per day per 100,000 elderly patients (P < 0.001), but there were no statistically significant changes in trends
Summary
The World Health Organization has reported that depression contributes greatly to the worldwide disease burden: depression was the third leading contributor in 2004 and is predicted to be the leading contributor by 2030 [1]. According to the Beers criteria [3], PRISCUS list [4], Norwegian General Practice (NORGEP) criteria [5], and French consensus panel list [6], TCAs are potentially inappropriate medications (PIMs) for the elderly regardless of the disease, owing to their highly anticholinergic, cognitive impairment, and cardiotoxic effects. Since October 1, 2015, nearly every prescriber who prescribes TCAs to the outpatients aged 65 years or more receives the following real-time pop-up window by a nationwide computerized drug utilization review (DUR) monitoring system [9]: BTCAs should be cautiously administered at low doses to the elderly because of adverse events such as orthostatic hypotension, stagger, dry mouth, dysuria, constipation, and increased intraocular pressure due to an anticholinergic effect.^
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