Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population

William V Bobo, Brandon R. Grossardt, Maria Isabel Lapid, Jonathan G. Leung, Cynthia Stoppel, Paul Y Takahashi, Robert W. Hoel, Zheng Chang, Christian Lachner, Mohit Chauhan, Lee Flowers, Scott M. Brue, Mark A Frye, Jennifer St. Sauver, Walter A Rocca, Bruce Sutor

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

The purpose of this study was to estimate the extent of potential antidepressant overprescribing in a geographically defined U.S. population, and to determine the indications and factors that account for it. We conducted a cohort study of new antidepressant prescriptions for elderly residents of Olmsted County, Minnesota, 2005-2012, using the Rochester Epidemiology Project medical records-linkage system. Indications for antidepressants were abstracted from health records for all cohort members. Potential antidepressant overprescribing was defined based on regulatory approval, the level of evidence identified from a standardized drug information database, and multidisciplinary expert review. Predictors of potential antidepressant overprescribing were investigated using logistic regression models, stratified by general antidepressant indication (general medical indication, specific psychiatric diagnosis, and non-specific psychiatric symptoms). Potential antidepressant overprescribing occurred in 24% of 3199 incident antidepressant prescriptions during the study period, and involved primarily newer antidepressants that were prescribed for non-specific psychiatric symptoms and subthreshold diagnoses. Potential antidepressant overprescribing was associated with nursing home residence, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, having greater use of urgent or acute care services in the year preceding the index antidepressant prescription, and being prescribed antidepressants via telephone, e-mail, or patient portal. In conclusion, potential antidepressant overprescribing occurred in elderly persons and involved mainly newer antidepressants used for non-specific psychiatric symptoms and subthreshold diagnoses, and was associated with indicators of higher clinical complexity or severity and with prescribing without face-to-face patient contact.

Original languageEnglish (US)
Pages (from-to)e00461
JournalPharmacology research & perspectives
Volume7
Issue number1
DOIs
StatePublished - Feb 1 2019

Fingerprint

Antidepressive Agents
Population
Prescriptions
Psychiatry
Medical Record Linkage
Logistic Models
Pharmaceutical Databases
Postal Service
Nursing Homes
Telephone
Mental Disorders
Epidemiology
Cohort Studies
Outpatients

Keywords

  • antidepressants
  • cohort study
  • elderly
  • overuse
  • prescribing

ASJC Scopus subject areas

  • Neurology
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population. / Bobo, William V; Grossardt, Brandon R.; Lapid, Maria Isabel; Leung, Jonathan G.; Stoppel, Cynthia; Takahashi, Paul Y; Hoel, Robert W.; Chang, Zheng; Lachner, Christian; Chauhan, Mohit; Flowers, Lee; Brue, Scott M.; Frye, Mark A; St. Sauver, Jennifer; Rocca, Walter A; Sutor, Bruce.

In: Pharmacology research & perspectives, Vol. 7, No. 1, 01.02.2019, p. e00461.

Research output: Contribution to journalArticle

Bobo, William V ; Grossardt, Brandon R. ; Lapid, Maria Isabel ; Leung, Jonathan G. ; Stoppel, Cynthia ; Takahashi, Paul Y ; Hoel, Robert W. ; Chang, Zheng ; Lachner, Christian ; Chauhan, Mohit ; Flowers, Lee ; Brue, Scott M. ; Frye, Mark A ; St. Sauver, Jennifer ; Rocca, Walter A ; Sutor, Bruce. / Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population. In: Pharmacology research & perspectives. 2019 ; Vol. 7, No. 1. pp. e00461.
@article{95c6afad392b40a4979a58aeb6509b6a,
title = "Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population",
abstract = "The purpose of this study was to estimate the extent of potential antidepressant overprescribing in a geographically defined U.S. population, and to determine the indications and factors that account for it. We conducted a cohort study of new antidepressant prescriptions for elderly residents of Olmsted County, Minnesota, 2005-2012, using the Rochester Epidemiology Project medical records-linkage system. Indications for antidepressants were abstracted from health records for all cohort members. Potential antidepressant overprescribing was defined based on regulatory approval, the level of evidence identified from a standardized drug information database, and multidisciplinary expert review. Predictors of potential antidepressant overprescribing were investigated using logistic regression models, stratified by general antidepressant indication (general medical indication, specific psychiatric diagnosis, and non-specific psychiatric symptoms). Potential antidepressant overprescribing occurred in 24{\%} of 3199 incident antidepressant prescriptions during the study period, and involved primarily newer antidepressants that were prescribed for non-specific psychiatric symptoms and subthreshold diagnoses. Potential antidepressant overprescribing was associated with nursing home residence, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, having greater use of urgent or acute care services in the year preceding the index antidepressant prescription, and being prescribed antidepressants via telephone, e-mail, or patient portal. In conclusion, potential antidepressant overprescribing occurred in elderly persons and involved mainly newer antidepressants used for non-specific psychiatric symptoms and subthreshold diagnoses, and was associated with indicators of higher clinical complexity or severity and with prescribing without face-to-face patient contact.",
keywords = "antidepressants, cohort study, elderly, overuse, prescribing",
author = "Bobo, {William V} and Grossardt, {Brandon R.} and Lapid, {Maria Isabel} and Leung, {Jonathan G.} and Cynthia Stoppel and Takahashi, {Paul Y} and Hoel, {Robert W.} and Zheng Chang and Christian Lachner and Mohit Chauhan and Lee Flowers and Brue, {Scott M.} and Frye, {Mark A} and {St. Sauver}, Jennifer and Rocca, {Walter A} and Bruce Sutor",
year = "2019",
month = "2",
day = "1",
doi = "10.1002/prp2.461",
language = "English (US)",
volume = "7",
pages = "e00461",
journal = "Pharmacology Research and Perspectives",
issn = "2052-1707",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "1",

}

TY - JOUR

T1 - Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population

AU - Bobo, William V

AU - Grossardt, Brandon R.

AU - Lapid, Maria Isabel

AU - Leung, Jonathan G.

AU - Stoppel, Cynthia

AU - Takahashi, Paul Y

AU - Hoel, Robert W.

AU - Chang, Zheng

AU - Lachner, Christian

AU - Chauhan, Mohit

AU - Flowers, Lee

AU - Brue, Scott M.

AU - Frye, Mark A

AU - St. Sauver, Jennifer

AU - Rocca, Walter A

AU - Sutor, Bruce

PY - 2019/2/1

Y1 - 2019/2/1

N2 - The purpose of this study was to estimate the extent of potential antidepressant overprescribing in a geographically defined U.S. population, and to determine the indications and factors that account for it. We conducted a cohort study of new antidepressant prescriptions for elderly residents of Olmsted County, Minnesota, 2005-2012, using the Rochester Epidemiology Project medical records-linkage system. Indications for antidepressants were abstracted from health records for all cohort members. Potential antidepressant overprescribing was defined based on regulatory approval, the level of evidence identified from a standardized drug information database, and multidisciplinary expert review. Predictors of potential antidepressant overprescribing were investigated using logistic regression models, stratified by general antidepressant indication (general medical indication, specific psychiatric diagnosis, and non-specific psychiatric symptoms). Potential antidepressant overprescribing occurred in 24% of 3199 incident antidepressant prescriptions during the study period, and involved primarily newer antidepressants that were prescribed for non-specific psychiatric symptoms and subthreshold diagnoses. Potential antidepressant overprescribing was associated with nursing home residence, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, having greater use of urgent or acute care services in the year preceding the index antidepressant prescription, and being prescribed antidepressants via telephone, e-mail, or patient portal. In conclusion, potential antidepressant overprescribing occurred in elderly persons and involved mainly newer antidepressants used for non-specific psychiatric symptoms and subthreshold diagnoses, and was associated with indicators of higher clinical complexity or severity and with prescribing without face-to-face patient contact.

AB - The purpose of this study was to estimate the extent of potential antidepressant overprescribing in a geographically defined U.S. population, and to determine the indications and factors that account for it. We conducted a cohort study of new antidepressant prescriptions for elderly residents of Olmsted County, Minnesota, 2005-2012, using the Rochester Epidemiology Project medical records-linkage system. Indications for antidepressants were abstracted from health records for all cohort members. Potential antidepressant overprescribing was defined based on regulatory approval, the level of evidence identified from a standardized drug information database, and multidisciplinary expert review. Predictors of potential antidepressant overprescribing were investigated using logistic regression models, stratified by general antidepressant indication (general medical indication, specific psychiatric diagnosis, and non-specific psychiatric symptoms). Potential antidepressant overprescribing occurred in 24% of 3199 incident antidepressant prescriptions during the study period, and involved primarily newer antidepressants that were prescribed for non-specific psychiatric symptoms and subthreshold diagnoses. Potential antidepressant overprescribing was associated with nursing home residence, having a higher number of comorbid medical conditions and outpatient prescribers, taking more concomitant medications, having greater use of urgent or acute care services in the year preceding the index antidepressant prescription, and being prescribed antidepressants via telephone, e-mail, or patient portal. In conclusion, potential antidepressant overprescribing occurred in elderly persons and involved mainly newer antidepressants used for non-specific psychiatric symptoms and subthreshold diagnoses, and was associated with indicators of higher clinical complexity or severity and with prescribing without face-to-face patient contact.

KW - antidepressants

KW - cohort study

KW - elderly

KW - overuse

KW - prescribing

UR - http://www.scopus.com/inward/record.url?scp=85060622637&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060622637&partnerID=8YFLogxK

U2 - 10.1002/prp2.461

DO - 10.1002/prp2.461

M3 - Article

VL - 7

SP - e00461

JO - Pharmacology Research and Perspectives

JF - Pharmacology Research and Perspectives

SN - 2052-1707

IS - 1

ER -