MHC3 Factors Predicting Potentially Inappropriate Psychotropic Prescribing for the Elderly

Abstract

With the widespread use of psychotropics in the elderly, issues related to the availability and appropriate use of psychotropic medications in older patients have become a concern from both therapeutic and economic viewpoints. OBJECTIVE: The purpose of this study was to examine the factors predicting potentially inappropriate psychotropic prescribing for the elderly in office-based practice. METHODS: This study utilized data from the National Ambulatory Medical Care Survey (NAMCS) 1995 to examine psychotropic agents that should be generally avoided in the elderly, based on the criteria previously developed through a consensus process. These included diazepam, chlordiazepoxide, meprobamate, flurazepam, pentobarbital, secobarbital, and amitriptyline. Psychotropic drugs considered inappropriate based on an excessive dosage or excessive duration of therapy were not examined due to the limitations of the data source. National visit estimates were derived based on the patient sampling weight provided for the NAMCS. RESULTS: Approximately 2.03 million (95% CI, 1.70–2.36 million) visits by the elderly involved potentially in appropriate psychotropic medications. Only two potentially inappropriate psychotropic medications, secobarbital and pentobarbital, were not prescribed for the elderly by office-based physicians. The remaining five potentially inappropriate medications accounted for 16.85% of the visits involving psychotropic medications, with amitriptyline alone accounting for over 10%. The most frequently prescribed potentially inappropriate psychotropic classes were antidepressants and antianxiety agents. The logistic analysis results revealed that patient characteristics (injury visit), drug characteristics (number of medications and drug classes), and physician characteristics (specialty and region) predict potentially inappropriate psychotropic prescribing. CONCLUSION: The psychotropic prescribing patterns in ambulatory settings raise concerns regarding the quality of care for the elderly with psychiatric illnesses. The predictive factors may be used to design effective educational and regulatory strategies to improve prescribing for the elderly.