Factors associated with the type of psychotropic medications purchased for common mental disorders in the largest managed care organization in Israel.
ABSTRACT To evaluate patient and physician characteristics associated with the type of psychotropic medications (anti-anxiety, antidepressant, or both) purchased.
The Clalit Health Care Services is the largest managed care health fund in Israel, a country that employs a universal healthcare system. We randomly sampled 30,000 primary care patients over the age of 22 as of January, 2006.
Overall, 2,217 purchased either antidepressant or antianxiety medications at least once during the year 2006 and had no prior purchases during the last quarter of 2005. The majority (1,518; 68.4%) purchased only anti-anxiety medications and as many as 264 (12%) purchased both anti-anxiety and antidepressant medications. The remaining 435 (19.6%) patients purchased only antidepressant medications. Physician level characteristics explained only a small portion of the variance and, thus, were not included in further analysis. Several patient level characteristics, including age, somatic, and psychiatric diagnosis were associated with the purchase of different types of medications.
Contrary to clinical guidelines, the purchase of anti-anxiety medications is more prevalent than the purchase of antidepressant medications. In a managed care setting, patient characteristics have a greater role in determining purchasing patterns than provider characteristics; potentially, because of the managed care characteristics that actively guide the care provided to patients.
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ABSTRACT: To investigate benzodiazepine usage and the characteristics associated with usage among elderly outpatients in Taiwan. This was an observational study of subjects who were enrolled in the National Health Insurance program and aged at least 65 in 2002. They were grouped according to treatment period and mean dosage. An ordered logit regression model was used to evaluate associations of characteristics with benzodiazepine usage. Of the 4,267 elderly people included, 1,826 had received at least one prescription for benzodiazepines. The 1-year prevalence of benzodiazepine usage by elderly outpatients was approximately 43%. Characteristics associated with receiving benzodiazepine therapy included female gender, displaying comorbid insomnia, anxiety, depression, other mental diseases, cardiovascular disease, cancer, chronic obstructive pulmonary disease, arthritis, and previous use of benzodiazepines. Individuals older than 75 years, with comorbid insomnia, anxiety, depression, other mental diseases, cardiovascular disease, cancer, being in previous receipt of benzodiazepines, or high prescription-overlap ratio were more likely to receive longer treatment. Individuals with insomnia, anxiety, depression, and previous use of higher cumulative dosage of benzodiazepine were more likely to receive higher-dosage therapy. Mental disorders and previous exposure to higher cumulative dosages of benzodiazepines are associated with an increased likelihood of receiving benzodiazepine therapy, longer treatment, and a higher mean dosage. Older individuals, less likely to receive higher dosage benzodiazepine therapy, are more likely to receive more prolonged therapy. Women are more likely to receive benzodiazepine therapy, but both men and women have comparable benzodiazepine usage patterns.International Journal of Geriatric Psychiatry 06/2008; 23(6):618-24. DOI:10.1002/gps.1950 · 3.09 Impact Factor
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ABSTRACT: The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up. The percent of patients who died of comorbid disease for the different scores were: "0", 8% (588); "1", 25% (54); "2", 48% (25); "greater than or equal to 3", 59% (18). With each increased level of the comorbidity index, there were stepwise increases in the cumulative mortality attributable to comorbid disease (log rank chi 2 = 165; p less than 0.0001). In this longer follow-up, age was also a predictor of mortality (p less than 0.001). The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.Journal of Chronic Diseases 02/1987; 40(5):373-83. DOI:10.1016/0021-9681(87)90171-8
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ABSTRACT: There is a continued high prevalence of benzodiazepine use by older community-residing adults and of their continued prescription by practitioners, despite well known adverse effects and the availability of safer, effective alternatives. To understand factors influencing chronic use of benzodiazepines in older adults. Qualitative study, semistructured interviews with physicians. Thirty-three practicing primary care physicians around Philadelphia. Qualitative interviews were audiotaped, transcribed, and entered into a qualitative software program. A multidisciplinary team coded transcripts and developed themes. Physicians generally endorsed benzodiazepines as effective treatment for anxiety, citing quick action and strong patient satisfaction. The use of benzodiazepines in older adults was not seen to be problematic because they did not show drug-seeking or escalating dose behavior suggesting addiction. Physicians minimized other risks of benzodiazepines and did not view monitoring or restricting renewal of prescriptions as an important clinical focus relative to higher-priority medical issues. Many physicians expressed skepticism about risks of continued use and considerable pessimism in the successful taper/discontinuation in older patients with long-term use and prior failed attempts. Physicians also anticipated patient resistance to any such efforts, including switching physicians. Primary care physicians are averse to addressing the public health problem of benzodiazepine overuse in the elderly. Their attitudes generally conflict with practice guidelines and they complain of a lack of training in constructive strategies to address this problem. A 2-pronged effort should focus on increasing skill level and preventing new cases of benzodiazepine dependency through improved patient education and vigilant monitoring of prescription renewal.Journal of General Internal Medicine 04/2007; 22(3):303-7. DOI:10.1007/s11606-006-0021-3 · 3.42 Impact Factor