Magnitude of potentially inappropriate prescribing in Germany among older patients with generalized anxiety disorder

被引：14

作者：

Berger A. ^{[1
]}

Mychaskiw M. ^{[2
]}

Dukes E. ^{[3
]}

Edelsberg J. ^{[1
]}

Oster G. ^{[1
]}

机构：

[1] Policy Analysis, Inc., Brookline

[2] Worldwide Medical and Outcomes Research, Pfizer, Inc., New York City, NY

[3] Global Outcomes Research, Pfizer, Inc., New York City, NY

来源：

BMC Geriatrics | / 9卷 / 1期

关键词：

Amitriptyline; Generalize Anxiety Disorder; Buspirone; Doxepin; Medical Expenditure Panel Survey;

D O I：

10.1186/1471-2318-9-31

中图分类号：

学科分类号：

摘要：

Background. Several medications commonly used to treat generalized anxiety disorder (GAD) have been designated "potentially inappropriate" for use in patients aged ≥65 years because their risks may outweigh their potential benefits. The actual extent of use of these agents in clinical practice is unknown, however. Methods. Using a database with information from encounters with general practitioners (GP) in Germany, we identified all patients, aged ≥65 years, with any GP office visits or dispensed prescriptions with a diagnosis of GAD (ICD-10 diagnosis code F41.1) between 10/1/2003 and 9/30/2004 ("GAD patients"). Among GAD-related medications (including benzodiazepines, tricyclic antidepressants [TCAs], selective serotonin reuptake inhibitors, venlafaxine, hydroxyzine, buspirone, pregabalin, and trifluoperazine), long-acting benzodiazepines, selected short-acting benzodiazepines at relatively high dosages, selected TCAs, and hydroxyzine were designated "potentially inappropriate" for use in patients aged ≥ 65 years, based on published criteria. Results. A total of 975 elderly patients with GAD were identified. Mean age was 75 years, and 72% were women; 29% had diagnoses of comorbid depression. Forty percent of study subjects received potentially inappropriate agents - most commonly, bromazepam (10% of all subjects), diazepam (9%), doxepin (7%), amitriptyline (5%), and lorazepam (5%). Twenty-three percent of study subjects received long-acting benzodiazepines, 10% received short-acting benzodiazepines at relatively high doses, and 12% received TCAs designated as potentially inappropriate. Conclusion. GPs in Germany often prescribe medications that have been designated as potentially inappropriate to their elderly patients with GAD - especially those with comorbid depressive disorders. Further research is needed to ascertain whether there are specific subgoups of elderly patients with GAD for whom the benefits of these medications outweigh their risks. © 2009 Berger et al; licensee BioMed Central Ltd.

引用

共 31 条

[1]

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, (2000)

[2]

Kessler R., Berglund P., Demler O., Et al., Lifetime prevalence and age of onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication, Arch Gen Psychiatry, 62, pp. 593-602, (2005)

[3]

Ormel J., Vonkorff M., Ustun T., Et al., Common mental disorders and disability across cultures: Results from the WHO collaborative study on psychological problems in general health care, JAMA, 272, pp. 1741-1748, (1994)

[4]

Wittchen H.U., Kessler R.C., Beesdo K., Et al., Generalized anxiety and depression in primary care: Prevalence, recognition, and management, J Clin Psychiatry, 63, SUPPL. 8, pp. 24-34, (2002)

[5]

Baldwin D.S., Anderson I.M., Nutt D.J., Et al., Evidence-based guidelines for the pharmacological treatment of anxiety disorders: Recommendations from the British Association for Psychopharmacology, J Psychopharmacol, 19, pp. 567-596, (2005)

[6]

Gorman J.M., Treating generalized anxiety disorder, J Clin Psychiatry, 64, SUPPL. 2, pp. 24-29, (2003)

[7]

Rickels K., Schweizer E., The spectrum of generalised anxiety in clinical practice: The role of short-term, intermittent treatment, Br J Psych, 34, pp. 49-54, (1998)

[8]

Shader R.I., Greenblatt D.J., Use of benzodiazepines in anxiety disorders, N Engl J Med, 328, pp. 1398-1405, (1993)

[9]

Oster G., Huse D.M., Adams S.F., Et al., Benzodiazepine tranquilizers and the risk of accidental injury, Am J Pub Health, 90, pp. 1467-1470, (1990)

[10]

Beers M.H., Ouslander J.G., Rollinger I., Et al., Explicit criteria for determining inappropriate medication use in nursing home residents, Arch Intern Med, 151, pp. 1825-1832, (1991)

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