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.
S Jill Stocks, Evangelos Kontopantelis, Roger T Webb, Anthony J Avery, Alistair Burns, Darren M Ashcroft, Antipsychotic Prescribing to Patients Diagnosed with Dementia Without a Diagnosis of Psychosis in the Context of National Guidance and Drug Safety Warnings Longitudinal Study in UK General Practice. Drug Safety, 40(8), 679-692, 2017.
Code | Description | Entity type | Category | Coding System (Read) |
---|---|---|---|---|
A411.00 | Jakob-Creutzfeldt disease | res53: P13_dementia | diagnostic | Read |
E00..00 | Senile and presenile organic psychotic conditions | res53: P13_dementia | diagnostic | Read |
E00..11 | Senile dementia | res53: P13_dementia | diagnostic | Read |
E00..12 | Senile/presenile dementia | res53: P13_dementia | diagnostic | Read |
E000.00 | Uncomplicated senile dementia | res53: P13_dementia | diagnostic | Read |
E001.00 | Presenile dementia | res53: P13_dementia | diagnostic | Read |
E001000 | Uncomplicated presenile dementia | res53: P13_dementia | diagnostic | Read |
E001100 | Presenile dementia with delirium | res53: P13_dementia | diagnostic | Read |
E001200 | Presenile dementia with paranoia | res53: P13_dementia | diagnostic | Read |
E001300 | Presenile dementia with depression | res53: P13_dementia | diagnostic | Read |
E001z00 | Presenile dementia NOS | res53: P13_dementia | diagnostic | Read |
E002.00 | Senile dementia with depressive or paranoid features | res53: P13_dementia | diagnostic | Read |
E002000 | Senile dementia with paranoia | res53: P13_dementia | diagnostic | Read |
E002100 | Senile dementia with depression | res53: P13_dementia | diagnostic | Read |
E002z00 | Senile dementia with depressive or paranoid features NOS | res53: P13_dementia | diagnostic | Read |
E003.00 | Senile dementia with delirium | res53: P13_dementia | diagnostic | Read |
E004.00 | Arteriosclerotic dementia | res53: P13_dementia | diagnostic | Read |
E004.11 | Multi infarct dementia | res53: P13_dementia | diagnostic | Read |
E004000 | Uncomplicated arteriosclerotic dementia | res53: P13_dementia | diagnostic | Read |
E004100 | Arteriosclerotic dementia with delirium | res53: P13_dementia | diagnostic | Read |
E004200 | Arteriosclerotic dementia with paranoia | res53: P13_dementia | diagnostic | Read |
E004300 | Arteriosclerotic dementia with depression | res53: P13_dementia | diagnostic | Read |
E004z00 | Arteriosclerotic dementia NOS | res53: P13_dementia | diagnostic | Read |
E00y.00 | Other senile and presenile organic psychoses | res53: P13_dementia | diagnostic | Read |
E00y.11 | Presbyophrenic psychosis | res53: P13_dementia | diagnostic | Read |
E00z.00 | Senile or presenile psychoses NOS | res53: P13_dementia | diagnostic | Read |
E012.00 | Other alcoholic dementia | res53: P13_dementia | diagnostic | Read |
E012.11 | Alcoholic dementia NOS | res53: P13_dementia | diagnostic | Read |
E012000 | Chronic alcoholic brain syndrome | res53: P13_dementia | diagnostic | Read |
E02y100 | Drug-induced dementia | res53: P13_dementia | diagnostic | Read |
E041.00 | Dementia in conditions EC | res53: P13_dementia | diagnostic | Read |
Eu00.00 | [X]Dementia in Alzheimer's disease | res53: P13_dementia | diagnostic | Read |
Eu00000 | [X]Dementia in Alzheimer's disease with early onset | res53: P13_dementia | diagnostic | Read |
Eu00011 | [X]Presenile dementia,Alzheimer's type | res53: P13_dementia | diagnostic | Read |
Eu00012 | [X]Primary degen dementia, Alzheimer's type, presenile onset | res53: P13_dementia | diagnostic | Read |
Eu00013 | [X]Alzheimer's disease type 2 | res53: P13_dementia | diagnostic | Read |
Eu00100 | [X]Dementia in Alzheimer's disease with late onset | res53: P13_dementia | diagnostic | Read |
Eu00111 | [X]Alzheimer's disease type 1 | res53: P13_dementia | diagnostic | Read |
Eu00112 | [X]Senile dementia,Alzheimer's type | res53: P13_dementia | diagnostic | Read |
Eu00113 | [X]Primary degen dementia of Alzheimer's type, senile onset | res53: P13_dementia | diagnostic | Read |
Eu00200 | [X]Dementia in Alzheimer's dis, atypical or mixed type | res53: P13_dementia | diagnostic | Read |
Eu00z00 | [X]Dementia in Alzheimer's disease, unspecified | res53: P13_dementia | diagnostic | Read |
Eu00z11 | [X]Alzheimer's dementia unspec | res53: P13_dementia | diagnostic | Read |
Eu01.00 | [X]Vascular dementia | res53: P13_dementia | diagnostic | Read |
Eu01.11 | [X]Arteriosclerotic dementia | res53: P13_dementia | diagnostic | Read |
Eu01000 | [X]Vascular dementia of acute onset | res53: P13_dementia | diagnostic | Read |
Eu01100 | [X]Multi-infarct dementia | res53: P13_dementia | diagnostic | Read |
Eu01111 | [X]Predominantly cortical dementia | res53: P13_dementia | diagnostic | Read |
Eu01200 | [X]Subcortical vascular dementia | res53: P13_dementia | diagnostic | Read |
Eu01300 | [X]Mixed cortical and subcortical vascular dementia | res53: P13_dementia | diagnostic | Read |
Eu01y00 | [X]Other vascular dementia | res53: P13_dementia | diagnostic | Read |
Eu01z00 | [X]Vascular dementia, unspecified | res53: P13_dementia | diagnostic | Read |
Eu02.00 | [X]Dementia in other diseases classified elsewhere | res53: P13_dementia | diagnostic | Read |
Eu02000 | [X]Dementia in Pick's disease | res53: P13_dementia | diagnostic | Read |
Eu02100 | [X]Dementia in Creutzfeldt-Jakob disease | res53: P13_dementia | diagnostic | Read |
Eu02200 | [X]Dementia in Huntington's disease | res53: P13_dementia | diagnostic | Read |
Eu02300 | [X]Dementia in Parkinson's disease | res53: P13_dementia | diagnostic | Read |
Eu02400 | [X]Dementia in human immunodef virus [HIV] disease | res53: P13_dementia | diagnostic | Read |
Eu02500 | [X]Lewy body dementia | res53: P13_dementia | diagnostic | Read |
Eu02y00 | [X]Dementia in other specified diseases classif elsewhere | res53: P13_dementia | diagnostic | Read |
Eu02z00 | [X] Unspecified dementia | res53: P13_dementia | diagnostic | Read |
Eu02z11 | [X] Presenile dementia NOS | res53: P13_dementia | diagnostic | Read |
Eu02z12 | [X] Presenile psychosis NOS | res53: P13_dementia | diagnostic | Read |
Eu02z13 | [X] Primary degenerative dementia NOS | res53: P13_dementia | diagnostic | Read |
Eu02z14 | [X] Senile dementia NOS | res53: P13_dementia | diagnostic | Read |
Eu02z15 | [X] Senile psychosis NOS | res53: P13_dementia | diagnostic | Read |
Eu02z16 | [X] Senile dementia, depressed or paranoid type | res53: P13_dementia | diagnostic | Read |
Eu04100 | [X]Delirium superimposed on dementia | res53: P13_dementia | diagnostic | Read |
Eu05700 | [X]Mild cognitive disorder | res53: P13_dementia | diagnostic | Read |
F110.00 | Alzheimer's disease | res53: P13_dementia | diagnostic | Read |
F110000 | Alzheimer's disease with early onset | res53: P13_dementia | diagnostic | Read |
F110100 | Alzheimer's disease with late onset | res53: P13_dementia | diagnostic | Read |
F111.00 | Pick's disease | res53: P13_dementia | diagnostic | Read |
F1110A | res53: P13_dementia | diagnostic | Read | |
F112.00 | Senile degeneration of brain | res53: P13_dementia | diagnostic | Read |
F116.00 | Lewy body disease | res53: P13_dementia | diagnostic | Read |
F118.00 | res53: P13_dementia | diagnostic | Read | |
F11x.00 | Cerebral degeneration in other disease EC | res53: P13_dementia | diagnostic | Read |
F11x000 | Cerebral degeneration due to alcoholism | res53: P13_dementia | diagnostic | Read |
F11x011 | Alcoholic encephalopathy | res53: P13_dementia | diagnostic | Read |
F11x200 | Cerebral degeneration due to cerebrovascular disease | res53: P13_dementia | diagnostic | Read |
F11x400 | Cerebral degeneration due to neoplastic disease | res53: P13_dementia | diagnostic | Read |
F11x500 | Cerebral degeneration due to myxoedema | res53: P13_dementia | diagnostic | Read |
F11x600 | Cerebral degeneration due to vitamin B12 deficiency | res53: P13_dementia | diagnostic | Read |
F11x700 | Cerebral degeneration due to Jakob - Creutzfeldt disease | res53: P13_dementia | diagnostic | Read |
F11x800 | Cerebral degeneration due to multifocal leucoencephalopathy | res53: P13_dementia | diagnostic | Read |
F11x900 | Cerebral degeneration in Parkinson's disease | res53: P13_dementia | diagnostic | Read |
F11xz00 | Cerebral degeneration other disease NOS | res53: P13_dementia | diagnostic | Read |
F11y.00 | Other cerebral degeneration | res53: P13_dementia | diagnostic | Read |
F11y000 | Reye's syndrome | res53: P13_dementia | diagnostic | Read |
F11y100 | Cerebral ataxia | res53: P13_dementia | diagnostic | Read |
F11yz00 | Other cerebral degeneration NOS | res53: P13_dementia | diagnostic | Read |
F11z.00 | Cerebral degeneration NOS | res53: P13_dementia | diagnostic | Read |
F11z.11 | Cerebral atrophy | res53: P13_dementia | diagnostic | Read |
F134.00 | Huntington's chorea | res53: P13_dementia | diagnostic | Read |
Fyu3000 | [X]Other Alzheimer's disease | res53: P13_dementia | diagnostic | Read |
To Export Phenotype Details:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH659/version/1318/detail/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH659/version/1318/detail/?format=json |
R Package |
|
To Export Phenotype Code List:
Format | API |
---|---|
XML | site_root/api/v1/public/phenotypes/PH659/version/1318/export/codes/?format=xml |
JSON | site_root/api/v1/public/phenotypes/PH659/version/1318/export/codes/?format=json |
CSV | site_root/phenotypes/PH659/version/1318/export/codes/ |
R Package |
|
Version ID |
Name | Owner | Publish date | |
---|---|---|---|---|
1318 | Dementia (P13) | ieuan.scanlon | 2021-10-06 | currently shown |
Export - export all codes into a csv file/JSON/XML for the current phenotype version.
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