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Differential Impact of Two Risk Communications on Antipsychotic Prescribing to People with Dementia in Scotland: Segmented Regression Time Series Analysis 2001-2011

机译：两种风险交流对苏格兰痴呆症患者抗精神病药物处方的影响：分段回归时间序列分析2001-2011

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Background: Regulatory risk communications are an important method for disseminating drug safety information, but their impact varies. Two significant UK risk communications about antipsychotic use in older people with dementia were issued in 2004 and 2009. These varied considerably in their content and dissemination, allowing examination of their differential impact.Methods:Segmented regression time-series analysis 2001-2011 for people aged ≥ 65 years with dementia in 87 Scottish general practices, examining the impact of two pre-specified risk communications in 2004 and 2009 on antipsychotic and other psychotropic prescribing.Results:The percentage of people with dementia prescribed an antipsychotic was 15.9% in quarter 1 2001 and was rising by an estimated 0.6%/quarter before the 2004 risk communication. The 2004 risk communication was sent directly to all prescribers, and specifically recommended review of all patients prescribed relevant drugs. It was associated with an immediate absolute reduction in antipsychotic prescribing of 5.9% (95% CI -6.6 to -5.2) and a change to a stable level of prescribing subsequently. The 2009 risk communication was disseminated in a limited circulation bulletin, and only specifically recommended avoiding initiation if possible. There was no immediate associated impact, but it was associated with a significant decline in prescribing subsequently which appeared driven by a decline in initiation, with the percentage prescribed an antipsychotic falling from 18.4% in Q1 2009 to 13.5% in Q1 2011. There was no widespread substitution of antipsychotics with other psychotropic drugs.Conclusions:The two risk communications were associated with reductions in antipsychotic use, in ways which were compatible with marked differences in their content and dissemination. Further research is needed to ensure that the content and dissemination of regulatory risk communications is optimal, and to track their impact on intended and unintended outcomes. Although rates are falling, antipsychotic prescribing in dementia in Scotland remains unacceptably high. © 2013 Guthrie et al.
机译：背景：监管风险沟通是传播药物安全信息的重要方法，但其影响各不相同。英国在2004年和2009年发布了两份关于老年痴呆症患者使用抗精神病药的重要风险通报。它们的内容和传播方式差异很大，可以检查其差异影响。方法：2001-2011年年龄段分段回归时间序列分析≥65岁的痴呆症患者共87种苏格兰常规病历，研究了2004年和2009年两次预先指定的风险通报对抗精神病药物和其他精神药物处方的影响。结果：2001年第1季度开具抗精神病药物的痴呆症患者比例为15.9％并且在2004年风险通报之前，估计每季度增长0.6％。 2004年风险通报已直接发送给所有处方者，并特别建议对所有处方相关药物的患者进行复查。它与抗精神病药物处方的绝对绝对值立即减少5.9％（95％CI -6.6至-5.2）以及随后改变为稳定的处方水平有关。 2009年的风险通报在有限的发行公告中进行了分发，仅特别建议尽可能避免启动。没有立即相关的影响，但与随后开处方的显着下降有关，这似乎是由启动次数的减少所驱动的，开具抗精神病药的比例从2009年第一季度的18.4％降至2011年第一季度的13.5％。结论：这两种风险交流与抗精神病药物的使用减少有关，其方式和内容和传播上的明显差异是相符的。需要进行进一步的研究，以确保监管风险沟通的内容和传播达到最佳状态，并跟踪其对预期和非预期结果的影响。尽管发病率正在下降，但苏格兰痴呆症的抗精神病药物处方仍然很高。 ©2013 Guthrie等。

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