1. Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia
- Author
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Adam G Elshaug, Benjamin Daniels, Jonathan Brett, Sallie-Anne Pearson, Nicholas A. Buckley, Helga Zoega, Miðstöð í lýðheilsuvísindum (HÍ), The Centre of Public Health Sciences (UI), Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, and University of Iceland
- Subjects
Adult ,Male ,Adolescent ,medicine.medical_treatment ,Context (language use) ,Pharmaceutical Benefits Scheme ,Choosing wisely ,Health administration ,Benzodiazepines ,03 medical and health sciences ,Elderly ,0302 clinical medicine ,Fullorðnir ,Environmental health ,Humans ,Antipsychotics ,Medicine ,Dementia ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Antipsychotic ,Residential Treatment ,Aged ,Aged, 80 and over ,Polypharmacy ,Psychotropic Drugs ,business.industry ,lcsh:Public aspects of medicine ,Health Policy ,Nursing research ,Australia ,lcsh:RA1-1270 ,Elliglöp ,Middle Aged ,medicine.disease ,Geðlyf ,Comorbidity ,3. Good health ,Practice Guidelines as Topic ,Female ,Health Services Research ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Publisher's version (útgefin grein), 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., This research was supported by the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Medicines and Ageing (CREMA), a Project Grant for measuring low-value care for targeted policy action and JB received funding support from an NHMRC Postgraduate award. These funding bodies played no role in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript.
- Published
- 2018
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