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The effects of medication assessment on psychotropic drug use in the community-dwelling elderly.

https://arctichealth.org/en/permalink/ahliterature140866
Source
Int Psychogeriatr. 2011 Apr;23(3):473-84
Publication Type
Article
Date
Apr-2011
Author
Maria Rikala
Maarit Jaana Korhonen
Raimo Sulkava
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. maria.rikala@uef.fi
Source
Int Psychogeriatr. 2011 Apr;23(3):473-84
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Aged - statistics & numerical data
Aged, 80 and over
Female
Finland
Geriatric Assessment - statistics & numerical data
Humans
Inappropriate Prescribing - statistics & numerical data
Interviews as Topic
Male
Psychotropic Drugs - adverse effects - therapeutic use
Questionnaires
Abstract
The study evaluated the effects of an annual medication assessment conducted as part of a Comprehensive Geriatric Assessment (CGA) on the prevalence of psychotropic drug use in community-dwelling elderly people.
Randomly selected persons (n = 1000) aged =75 years living in the city of Kuopio, Finland were randomized to intervention and control groups. The intervention group underwent an annual (2004-2006) medication assessment as part of a CGA by physicians. Data on drug use were gathered by interviews at baseline (2004) and in three following years (2005-2007). Generalized estimating equations (GEE) were applied to explore whether the prevalence of psychotropic drug use differed between the community-dwelling participants of the intervention (n = 361) and control groups (n = 339) over time.
At baseline, nearly 40% of the participants used psychotropic drugs in each group. In the intervention group, the study physicians implemented 126 psychotropic drug-related changes, 39% of which were persistent after one year. The prevalence of use of psychotropic drugs, antipsychotics and anxiolytic/hypnotics did not differ between the groups over time. The prevalence of antidepressant use remained constant in the intervention group, but increased in the control group (p-value for interaction = 0.039). The prevalence of concomitant use of psychotropic drugs decreased non-significantly in the intervention group, but increased in the control group (p-value for interaction = 0.009).
Conducting an annual medication assessment outside the usual primary health care system does not appear to reduce the prevalence of psychotropic drug use in community-dwelling elderly people. However, it may prevent concomitant use of psychotropic drugs.
PubMed ID
20836913 View in PubMed
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Validity of the Finnish Prescription Register for measuring psychotropic drug exposures among elderly finns: a population-based intervention study.

https://arctichealth.org/en/permalink/ahliterature144539
Source
Drugs Aging. 2010 Apr 1;27(4):337-49
Publication Type
Article
Date
Apr-1-2010
Author
Maria Rikala
Sirpa Hartikainen
Raimo Sulkava
Maarit Jaana Korhonen
Author Affiliation
Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio, Finland. maria.rikala@uef.fi
Source
Drugs Aging. 2010 Apr 1;27(4):337-49
Date
Apr-1-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antidepressive Agents - administration & dosage - pharmacology
Antipsychotic Agents - administration & dosage - pharmacology
Benzodiazepines - administration & dosage - pharmacology
Data Collection
Databases, Factual
Drug Prescriptions - statistics & numerical data
Drug Utilization - statistics & numerical data
Finland - epidemiology
Humans
Polypharmacy
Reproducibility of Results
Self Disclosure
Abstract
Pharmacoepidemiological studies assessing the associations between psychotropic drug use and adverse events in the elderly frequently employ automated pharmacy databases as the source of exposure data. However, information on the validity of these databases for estimating psychotropic drug exposures in elderly people is scarce.
This study evaluated the validity of the Finnish Prescription Register for estimating current exposures to psychotropic drugs in elderly people. Furthermore, the potential change in the validity over time was determined.
This was a population-based intervention study (GeMS; Geriatric Multidisciplinary Strategy for the Good Care of the Elderly) conducted between 2004 and 2007. Initially, 1000 randomly selected persons aged >or=75 years living in the City of Kuopio, Finland, in November 2003 were invited to participate in the study. Of these, 716 agreed to participate at baseline (2004) and 570 were still available for 3-year follow-up (2007). The validity of the Prescription Register was assessed by comparing it with the self-reported information collected by interviews in 2004 and in 2007 in the GeMS study. Using the self-reported data as a reference standard, sensitivity, specificity and Cohen's kappa statistic (measure of inter-rater agreement for qualitative [categorical] items) with 95% confidence intervals were computed for different categories and subcategories of psychotropic drugs, applying fixed-time windows of 4, 6 and 12 months.
In 2007, the sensitivity varied between psychotropic categories and subcategories, being generally highest with the 12-month time window (0.57-0.96). The specificity was highest with the 4-month time window (0.94-0.99), showing a slight tendency to decrease with an extended time window. The sensitivity and specificity were highest for antidepressants and antipsychotics, followed by benzodiazepines. The agreement was almost perfect (kappa = 0.81-1.00) or substantial (kappa = 0.61-0.80) for all categories and subcategories of psychotropic drugs. Few differences in validity were observed between the two years.
Using self-reported data as a reference standard, the Prescription Register provides valid information on current exposures to antidepressants and antipsychotics in elderly people if the time window is selected with adequate consideration. However, the validity is lower for benzodiazepines, suggesting that other sources of information should be considered when performing pharmacoepidemiological studies.
PubMed ID
20359263 View in PubMed
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