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Analysis of Influencing Factors on the Outpatient Prescription of Antipsychotic Drugs in the Elderly Patients

노인환자의 항정신병 약물 원외처방 내역에 미친 영향 요인 분석

  • Dong, Jae Yong (Department of Review and Assessment Research, Health Insurance Review and Assessment Service) ;
  • Lee, Hyun Ji (Department of Health Administration, Yonsei University Graduate School) ;
  • Lee, Tae Hoon (Department of Review and Assessment Research, Health Insurance Review and Assessment Service) ;
  • Kim, Yujeong (Department of Review and Assessment Research, Health Insurance Review and Assessment Service)
  • 동재용 (건강보험심사평가원 심사평가연구실) ;
  • 이현지 (연세대학교 일반대학원 보건행정학과) ;
  • 이태훈 (건강보험심사평가원 심사평가연구실) ;
  • 김유정 (건강보험심사평가원 심사평가연구실)
  • Received : 2021.08.30
  • Accepted : 2021.10.01
  • Published : 2021.12.31

Abstract

Background: Most antipsychotic drugs studies have been mainly conducted on side effects, randomized clinical trials, utilization rates, and trends. But there have been few studies on the influencing factors in elderly patients. The purpose of this study was to analyze the influencing factors on the outpatient prescription of antipsychotic drugs in the elderly patients. Methods: Active ingredients of antipsychotic drugs in Korea were selected according to the Korean Pharmaceutical Information Center (KPIC)'s classification. Data source was Korean Health Insurance Review and Assessment Service (HIRA) claims data in 2020 and target patient group was the elderly patient group. We extracted patients who have been prescribed one or more antipsychotic drugs and visited only one medical institution. Data were analyzed using descriptive statistics, chi-square, t-test, negative binomial regression. Results: A number of outpatients were 245,197 and prescriptions were 1,379,092. Most characteristics of patients were 75-85 year's old, female, health insurance type, no disease (dementia, schizophrenia), atypical drugs, cci score (>2) and characteristics of medical institution were neurology in specialty, rural region, general hospitals. Results of regression showed that patient's characteristics and medical center characteristics had significant effect on the outpatient prescription of antipsychotic drugs in the elderly patients. Conclusion: This study suggests that national policy of antipsychotic drugs in the elderly patients, with the consideration of the patients' and medical institutions' characteristics, is needed.

Keywords

References

  1. Kang YK, Lee PY, Bae YS. 2020 Statistics of Older People. Korean Statistical Information Service. 2020:1-83.
  2. Kim SM, Kim YI. National Health Insurance Statistical Yearbook. Health Insurance Review & Assessment Service, National Health Insurance Service. 2020:1-843.
  3. Lee YM. National Mental Health Statistics 2019. National Health Insurance Service National Center for Mental Health, Health Insurance Review & Assessment Service, Korea Institute for Health and Social Affairs. 2020:1-222.
  4. Park NH, Park MS, Woo YJ, et al. Health and Welfare Statistical Year Book 2020. National Health Insurance Service. 2020;1-669.
  5. Older Americans 2020 Key Indicators of Well-Being. The Federal Interagency Forum on Aging-Related Statistics. 2020:1-161.
  6. Members of executive of Faculty of Old Age Psychiatry, the Royal College of Psychiatrists. Suffering in silence: age inequality in older people's mental health care. The Royal College of Psychiatrists. 2018:1-32.
  7. New South Wales Government. NSW Older People's Mental Health Services SERVICE PLAN 2017-2027. Available from https://www.health.nsw.gov.au/mentalhealth/Pages/services-opmh.aspx. Accessed January 25, 2021.
  8. Yi JS. History and future of antipsychotic drugs. J Korean Neuropsychiatr Assoc 2019;58(1):2-11. https://doi.org/10.4306/jknpa.2019.58.1.2
  9. Oh BH. Outline of psychiatric disorders of the elderly. J Korean Med Assoc 2010;53(11):953-7. https://doi.org/10.5124/jkma.2010.53.11.953
  10. Won WY, Lee CU. Pharmacological treatment of psychiatric disorders of the elderly. J Korean Med Assoc 2010;53(11):972-83. https://doi.org/10.5124/jkma.2010.53.11.972
  11. Howland RH. Prescribing psychotropic medications for elderly patients. J Psychosoc Nurs Ment Health Serv 2009;47(11):17-20. https://doi.org/10.3928/02793695-20090930-06
  12. Korean Society for Drug Dynamics and Risk Management. Drug dynamics. 1st ed. Seoul: Seoul National University Publishing and Cultural Center, 2011: 394-401.
  13. Kim DH. Care points for drug use in elderly patients. The Korean Academy of Family Medicine 2007;28(11):209-25.
  14. Kim DS, Jeon HL, Park JH. DUR implementation on geriatric drug use. Health Insurance Review and Assessment Institute. Available from https://repository.hira.or.kr/handle/2019.oak/2406. Accessed January 20, 2021.
  15. Centorrino F, Goren JL, Hennen J, Salvatore P, Kelleher JP, Baldessarini RJ. Multiple versus single antipsychotic agents for hospitalized psychiatric patients: case-control study of risks versus benefits. Am J Psychiatry 2004;161(4):700-6. https://doi.org/10.1176/appi.ajp.161.4.700
  16. Waddington JL, Youssef HA, Kinsella A. Mortality in schizophrenia: Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study. Br J Psychiatry 1998;173(4): 325-329. https://doi.org/10.1192/bjp.173.4.325
  17. Ministry of Food and Drug Safety. Safety leaflets and card news for elderly people. Available from https://www.mfds.go.kr/brd/m_227/view.do?seq=33260. Accessed January 15, 2021.
  18. Shim IH, Woo YS, Jun TY, Kim KS, Bahk WM. Changes in antipsychotic drug usage in the psychiatric inpatients at a university hospital between 1997, 2003-2004 and 2009-2010. Korean J Psychopharmacol 2012;23(2):57-64.
  19. Byun SJ, Kim ET, Yoo HJ, Ha TH, Yoon IY, Kim KW. Changes in psychotropic prescription patterns in patients admitted to an open psychiatric ward: Eleven-year comparison in a university hospital in Gyeonggi-Do. Korean J Biol Psychiatry 2015;22(4);195-204.
  20. Park SY, Shin SH, Kim ET. Prescription pattern of atypical antipsychotics in a university psychiatric ward: 11-Year observational study. Korean J Schizophr Res 2016;19(2):68-77. https://doi.org/10.16946/kjsr.2016.19.2.68
  21. Ontario Drug Policy Research Network. Antipsychotics in the Elderly. Ontario Drug Policy Research Network. Available from https://odprn.ca/wp-content/uploads/2015/06/Antipsychotic-Pepi-Report.pdf. Accessed January 15, 2021.
  22. Lao KS, Tam AW, Wong IC, et al. Prescribing trends and indications of antipsychotic medication in Hong Kong from 2004 to 2014: general and vulnerable patient groups. Pharmacoepidemiol Drug Saf 2017;26(11):1387-94. https://doi.org/10.1002/pds.4244
  23. Ahn SH, Jung SY, Kim YJ, et al. Patterns of prescription of atypical antipsychotics in elderly ambulatory patients with dementia in Korea. Journal of Pharmacoepidemiology and Risk Management 2009;2:97-104.
  24. Yoon SM, Lee SW, Chang JE, Lee YS, Rhew KY. The prescribing patterns of antipsychotic drugs and antiparkinsonian drugs in elderly patients with dementia. Korean J Clin Pharm 2020;30(2):81-6. https://doi.org/10.24304/kjcp.2020.30.2.81
  25. Mark O, Marissa K, Michael S. Treatment of young people with antipsychotic medications in the United States. JAMA psychiatry 2015;72(9):867-74. https://doi.org/10.1001/jamapsychiatry.2015.0500
  26. Grace C, Laura G, Ann WM, James PT, Judy S, Dianne M. Trends of outpatient prescription drug utilization in US children, 2002-2010. Pediatrics 2012;130(1):23-31. https://doi.org/10.1542/peds.2011-2879
  27. Oskar H, Helga Z, Lise A, et al. International trends in antipsychotic use: a study in 16 countries, 2005-2014. Eur Neuropsychopharmacol 2017;27(10):1064-1076. https://doi.org/10.1016/j.euroneuro.2017.07.001
  28. Mikkel H, Anton P, Erik J, et al. Trends in utilization and dosing of antipsychotic drugs in Scandinavia: comparison of 2006 and 2016. Br J Clin Pharmacol 2019;85(7):1598-606. https://doi.org/10.1111/bcp.13945
  29. Helen CK, Kara Z, Hyungjin MK, et al. Trends in antipsychotic use in dementia 1999-2007. Arch Gen Psychiatry 2011;68(2):190-197. https://doi.org/10.1001/archgenpsychiatry.2010.200
  30. Indrajit B, Bedanta R, Brijesh S, Indraneel B, Prasanta KC, Archana S. Socio demographic profile and utilization pattern of antipsychotic drugs among schizophrenic inpatients: a cross sectional study from western region of Nepal. BMC psychiatry 2013;13(1):1-10. https://doi.org/10.1186/1471-244X-13-1
  31. Kim JA, Kim LY. Introduction and utilization of National HIRA claim data for healthcare research. Obstructive Lung Disease Research Foundation 2014;2(1);3-9.
  32. Korea Pharmaceutical Information Center. Available from https://www.health.kr/searchDrug/search_total_result.asp. Accessed April, 2021.
  33. Kim KH, Lee, DK, Kim KY, et al. Healthcare Quality Statistics as of 2018. Available from http://www.mohw.go.kr/react/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=032901&CONT_SEQ=352884. Accessed January 28, 2021.
  34. Kim YJ, Jung SY, Choi NK, et al. Benzodiazepine prescription patterns for the elderly patients at ambulatory care in Korea. Journal of Pharmacoepidemiology and Risk Management. 2008;1(1):60-7.
  35. Maust DT, Kim HM, Seyfried LS, et al. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA psychiatry 2015;72(5):438-45. https://doi.org/10.1001/jamapsychiatry.2014.3018
  36. Curkovic M, Dodig-Curkovic K, Eric AP, Kralik K, Pivac N. Psychotropic medications in older adults: a review. Psychiatr Danub 2016;28(1):13-24.
  37. Kheirbek RE, Fokar A, Little JT, et al. Association between antipsychotics and all-cause mortality among community-dwelling older adults. J Gerontol A Biol Sci Med Sci 2019;74(12):1916-21. https://doi.org/10.1093/gerona/glz045
  38. Choi WJ, Yim ES, Kim TH, Suh HS, Choi KC, Chung WJ. Analysis of factors related to the prescription of antibiotics for the acute upper respiratory infection. Health Policy and Management 2015;25(4):256-63. https://doi.org/10.4332/KJHPA.2015.25.4.256
  39. Jang EJ, Ann JH, Jung SY, et al. Methods for the control of measured confounders in outcomes research, 1st ed. Seoul: National evidence-based healthcare collaborating agency, 2013: 66-200.
  40. Kim MY, Cho HA, Shin HS. Provider factors related to dental healthcare utilization. The Korean Journal of Business Administration 2015;28(2):349-64.
  41. Gellad WF, Aspinall SL, Handler SM, et al. Use of antipsychotics among older residents in VA nursing homes. Med care 2012;50(11):954-60. https://doi.org/10.1097/MLR.0b013e31825fb21d
  42. Rege S, Sura S, Aparasu RR. Atypical antipsychotic prescribing in elderly patients with depression. Res Social Adm Pharm 2018;14(7):645-52. https://doi.org/10.1016/j.sapharm.2017.07.013
  43. Health Insurance Review & Assessment Service. Major statistics on medical expenses. Available from https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020045030000&brdScnBltNo=4&brdBltNo=2404&pageIndex=2. Accessed February 10, 2021.
  44. Kim SK, Lee DB. Psychopharmacological treatment patterns in patients with schizophrenia and schizoaffective disorder in forensic inpatient settings. Korean J Leg Med 2017;41(4):115-21. https://doi.org/10.7580/kjlm.2017.41.4.115
  45. Keks NA. Are atypical antipsychotics advantageous?-the case for. Aust Prescr 2004;27:146-9. https://doi.org/10.18773/austprescr.2004.120
  46. Tellez-Lapeira J, Lopez-Torres Hidalgo J, Garcia-Agua Soler N, Galvez-Alcaraz L, Escobar-Rabadan F, Garcia-Ruiz A. Prevalence of psychotropic medication use and associated factors in the elderly. Eur. J. Psychiat 2016;30(3):183-94.
  47. Gerhard T, Huybrechts K, Olfson M, et al. Comparative mortality risks of antipsychotic medications in community-dwelling older adults. Br J Psychiatry 2014;20-51.
  48. Kim YJ, Lee TH, Dong JY. Patient safety-oriented drug evaluation indicators Development Research. Available from https://www.hira.or.kr/rc/icenter/study/getReportInfo.do?pgmid=HIRAA030095000000. Accessed February 20, 2021.
  49. HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE. Detailed plan to evaluate the adequacy of hospitalization benefits in nursing hospitals. Available from http://www.hira.or.kr/bbsDummy.do;INTERSESSIONID=yjtQ3HsAHf0rejIbpwa6nmvrRVSZVDX8vByn3wFC2OjDyE-iDJhp!1762210808!1885459875?pgmid=HIRAA020002000100&brdScnBltNo=4&brdBltNo=8814. Accessed May 10, 2021.
  50. Lee KH, Choi YY. Factors affecting antibiotic prescription in dental outpatients - A nation-wide cohort study in Korea. J Korean Soc Dent Hyg 2019;19(3):409-19.