| アブストラクト | INTRODUCTION: Policy 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. METHODS: We 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. RESULTS: 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. Since 2013, the decreasing trend in second-generation antipsychotic drug prescribing has plateaued largely driven by the increasing prescribing of risperidone. CONCLUSIONS: Increased surveillance and evaluation of drug safety warnings and guidance are needed to improve the impact of future interventions. |
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| 組織名 | Division of Population Health, Health Services Research and Primary Care, School;of Health Sciences, National Institute for Health Research Greater Manchester;Primary Care Patient Safety Translational Research Centre, Centre for Primary;Care, University of Manchester, Manchester, UK. jill.stocks@manchester.ac.uk.;of Health Sciences, National Institute for Health Research School for Primary;Care Research, Centre for Primary Care, University of Manchester, Manchester, UK.;Division of Informatics, Imaging and Data Sciences, School of Health Sciences,;Centre for Health Informatics, University of Manchester, Manchester, UK.;Division of Psychology and Mental Health, School of Health Sciences, University;of Manchester, Manchester, UK.;Division of Primary Care, School of Medicine, Queen's Medical Centre, University;of Nottingham, Nottingham, UK.;Division of Neuroscience and Experimental Psychology, School of Biological;Sciences, University of Manchester, Manchester, UK.;Care, University of Manchester, Manchester, UK.;Division of Pharmacy and Optometry, School of Health Sciences, Centre for;Pharmacoepidemiology and Drug Safety, University of Manchester, Manchester;Academic Health Sciences Centre, Manchester, UK. |
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