Psychostimulant prescribing trends in a paediatric population in Ireland: a national cohort study

Fiona Boland,Nicola Motterlini,Udo Reulbach,Rose Galvin,Kathleen Bennett,Dervla Kelly,Tom Fahey

doi:10.1186/s12887-015-0435-3

Abstract

BackgroundPsychotropic paediatric prescribing trends are increasing internationally. The aim of this study is to examine the prevalence and secular trends in psychotropic prescribing in Irish children and adolescents between 2002 and 2011.MethodsData was obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive Primary Care Reimbursement Services (HSE-PCRS). Prescribing rates per 1000 eligible population and associated 95 % confidence intervals (CIs) were calculated across years (2002–2011), age groups (0–4, 5–11, 12–15 years) and gender. Rates of concomitant prescriptions for psycholeptics and antidepressants were also examined. The total expenditure costs were calculated and expressed as a percentage of the cost of all prescriptions for this age group (≤15 years).ResultsIn 2002, 3.77/1000 GMS population (95 % CI: 3.53–4.01) received at least one psychostimulant prescription and this rate increased to 8.63/1000 GMS population (95 % CI: 8.34–8.92) in 2011. Methylphenidate was the most frequently prescribed psychostimulant. For both males and females the prevalence of medication use was highest among the 12–15 year old group. On average, a psycholeptic medication was prescribed to 8 % of all psychostimulant users and an antidepressant was concomitantly prescribed on average to 2 %. Total expenditure rose from €89,254 in 2002 to €1,532,016 in 2011.ConclusionsThe rate and cost of psychostimulant prescribing among GMS children and adolescents in Ireland increased significantly between 2002 and 2011. Further research is necessary to assess the safety, efficacy and economic impact of concomitant psychotropic prescribing in this population.

Highlights

Psychotropic paediatric prescribing trends are increasing internationally
A further prescribing challenge faced by clinicians treating children with attention deficit hyperactivity disorder (ADHD) relates to the prescribing of multiple medicines as these children are more likely to have a diagnosis of other neurobehavioral disorders and to receive non-stimulant psychotropic medications [4]
In 2002, 3.77/1000 General Medical Services (GMS) population received at least one psychostimulant prescription and this rate increased to 8.63/1000 GMS population in 2011, representing a two-fold increase in psychostimulant prescribing over the study period

Summary

Introduction

Psychotropic paediatric prescribing trends are increasing internationally. The aim of this study is to examine the prevalence and secular trends in psychotropic prescribing in Irish children and adolescents between 2002 and 2011. One of the main indications for psychotropic prescribing in children is the psychostimulant treatment of attention deficit hyperactivity disorder (ADHD) [3]. This disorder is defined by a combination of developmentally inappropriate and maladaptive levels of inattention, hyperactivity and impulsivity which persist for at least 6 months and are Boland et al BMC Pediatrics (2015) 15:118. A further prescribing challenge faced by clinicians treating children with ADHD relates to the prescribing of multiple medicines as these children are more likely to have a diagnosis of other neurobehavioral disorders and to receive non-stimulant psychotropic medications [4]. The benefit of a polypharmacy treatment strategy for children with ADHD is unclear and there remain questions regarding efficacy, safety and role of any combination therapy [21]

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