Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia
Abstract 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...
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doaj-b55a04df0913413cb8cb3807b4bcb2a42020-11-25T03:30:34ZengBMCBMC Health Services Research1472-69632018-12-011811810.1186/s12913-018-3811-5Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in AustraliaJonathan Brett0Helga Zoega1Nicholas A. Buckley2Benjamin J. Daniels3Adam G. Elshaug4Sallie-Anne Pearson5Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South WalesMedicines Policy Research Unit, Centre for Big Data Research in Health, University of New South WalesSchool of Medicine, The University of SydneyMedicines Policy Research Unit, Centre for Big Data Research in Health, University of New South WalesMenzies Centre for Health Policy, The University of SydneyMedicines Policy Research Unit, Centre for Big Data Research in Health, University of New South WalesAbstract 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.http://link.springer.com/article/10.1186/s12913-018-3811-5ElderlyBenzodiazepinesAntipsychoticsDementiaPolypharmacyChoosing wisely |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jonathan Brett Helga Zoega Nicholas A. Buckley Benjamin J. Daniels Adam G. Elshaug Sallie-Anne Pearson |
spellingShingle |
Jonathan Brett Helga Zoega Nicholas A. Buckley Benjamin J. Daniels Adam G. Elshaug Sallie-Anne Pearson Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia BMC Health Services Research Elderly Benzodiazepines Antipsychotics Dementia Polypharmacy Choosing wisely |
author_facet |
Jonathan Brett Helga Zoega Nicholas A. Buckley Benjamin J. Daniels Adam G. Elshaug Sallie-Anne Pearson |
author_sort |
Jonathan Brett |
title |
Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia |
title_short |
Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia |
title_full |
Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia |
title_fullStr |
Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia |
title_full_unstemmed |
Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia |
title_sort |
choosing wisely? quantifying the extent of three low value psychotropic prescribing practices in australia |
publisher |
BMC |
series |
BMC Health Services Research |
issn |
1472-6963 |
publishDate |
2018-12-01 |
description |
Abstract 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. |
topic |
Elderly Benzodiazepines Antipsychotics Dementia Polypharmacy Choosing wisely |
url |
http://link.springer.com/article/10.1186/s12913-018-3811-5 |
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