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Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia

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dc.contributor Háskóli Íslands
dc.contributor University of Iceland
dc.contributor.author Brett, Jonathan
dc.contributor.author Zoega, Helga
dc.contributor.author Buckley, Nicholas A.
dc.contributor.author Daniels, Benjamin J.
dc.contributor.author Elshaug, Adam G.
dc.contributor.author Pearson, Sallie-Anne
dc.date.accessioned 2019-04-03T12:52:04Z
dc.date.available 2019-04-03T12:52:04Z
dc.date.issued 2018-12
dc.identifier.citation Brett, J., Zoega, H., Buckley, N. A., Daniels, B. J., Elshaug, A. G., & Pearson, S.-A. (2018). Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia. BMC Health Services Research, 18(1), 1009. doi:10.1186/s12913-018-3811-5
dc.identifier.issn 1472-6963
dc.identifier.uri https://hdl.handle.net/20.500.11815/1089
dc.description Publisher's version (útgefin grein)
dc.description.abstract Background The global Choosing Wisely campaign has identified the following psychotropic prescribing as low-value (harmful or wasteful): (1) benzodiazepine use in the elderly, (2) antipsychotic use in dementia and (3) prescribing two or more antipsychotics concurrently. We aimed to quantify the extent of these prescribing practices in the Australian population. Methods We applied indicators to dispensing claims of a 10% random sample of Australian Pharmaceutical Benefits Scheme beneficiaries to quantify annual rates of each low-value practice from 2013 to 2016. We also assessed patient factors and direct medicine costs (extrapolated to the entire Australian population) associated with each practice in 2016. Results We observed little change in the rates of the three practices between 2013 and 2016. In 2016, 15.3% of people aged ≥65 years were prescribed a benzodiazepine, 0.5% were prescribed antipsychotics in the context of dementia and 0.2% of people aged ≥18 years received two or more antipsychotics concurrently. The likelihood of elderly people receiving benzodiazepines or antipsychotics in the context of dementia increased with age and the likelihood of receiving all three practices increased with comorbidity burden. In 2016, direct medicine costs to the government of all three practices combined, extrapolated to national figures, were > $21 million AUD. Conclusions Our indicators suggest that the frequency of these three practices has not changed appreciably in recent years and that they incur significant costs. Worryingly, people with the greatest risk of harm from these prescribing practices are often the most likely to receive them.
dc.description.sponsorship This research was supported by the National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Medicines and Ageing (CREMA), a Project Grant for measuring low-value care for targeted policy action and JB received funding support from an NHMRC Postgraduate award. These funding bodies played no role in the design of the study and collection, analysis, and interpretation of data or in writing the manuscript.
dc.format.extent 1009
dc.language.iso en
dc.publisher Springer Nature
dc.relation.ispartofseries BMC Health Services Research;18(1)
dc.rights info:eu-repo/semantics/openAccess
dc.subject Elderly
dc.subject Benzodiazepines
dc.subject Antipsychotics
dc.subject Dementia
dc.subject Polypharmacy
dc.subject Choosing wisely
dc.subject Fullorðnir
dc.subject Geðlyf
dc.subject Elliglöp
dc.title Choosing wisely? Quantifying the extent of three low value psychotropic prescribing practices in Australia
dc.type info:eu-repo/semantics/article
dcterms.license This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
dc.description.version Peer Reviewed
dc.identifier.journal BMC Health Services Research
dc.identifier.doi 10.1186/s12913-018-3811-5
dc.relation.url http://link.springer.com/content/pdf/10.1186/s12913-018-3811-5.pdf
dc.contributor.department Miðstöð í lýðheilsuvísindum (HÍ)
dc.contributor.department The Centre of Public Health Sciences (UI)
dc.contributor.department Læknadeild (HÍ)
dc.contributor.department Faculty of Medicine (UI)
dc.contributor.school Heilbrigðisvísindasvið (HÍ)
dc.contributor.school School of Health Sciences (UI)

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