Expenditures for psychotropic medications in the United States in 1985.

OBJECTIVE: Psychotropic medications have seldom been included in estimates of the costs of mental health services. In the infrequent case that these costs have been assessed, they have been estimated by using national surveys of consumers of health services. The objective of this study was to estimate the costs of prescriptions for psychotropic medications in the United States in 1985 and to assess the difference with the most recent cost estimate from a health services survey (1977). METHOD: Study data were based on retail costs of psychotropic medications reported to the Pharmaceutical Data Service Alpha National Prescription and Sales Audit. The data come from a computerized survey panel of 2,250 pharmacies representative of the more than 14,000 pharmacies nationwide. The database includes all medication prescriptions filled, whether paid with cash or Medicaid or reimbursed by third-party payment. Analyses were limited to psychotropic medication prescriptions. RESULTS: In 1985, $1.45 billion was spent on outpatient psychotropic medications. Nearly $868 million (60% of the total) was spent on antianxiety and sedative-hypnotic medications, while approximately $263 million (18%) was spent on antipsychotic medications, $240 million (17%) on antidepressants, and $84 million (5%) on combination psychotropic medications. These expenditures were much higher than would have been expected given the most recent health services estimate of $513 million. CONCLUSIONS: These results demonstrate the substantial cost of psychotropic medications in 1985. The finding that the cost of psychotropic medications was so high, in contrast to the lower estimate from the 1977 survey, demonstrates the importance of obtaining more frequent cost estimates and basing future estimates on medication databases.

Psychotropic medication prescription in U.S. ambulatory medical care.

Because of the pharmacologic power of psychotropic medications, the potential for adverse effects, and the changing popularity of particular psychotropic drugs, it is vital for pharmacoepidemiologists to monitor the prescribing patterns of these medications. Using data from the 1985 National Ambulatory Medical Care Survey (NAMCS), this article assesses psychotropic medication prescribing by U.S. ambulatory care physicians. Psychotropic medications are classified into three categories: minor tranquilizers (i.e., anxiolytics and sedative-hypnotics), antidepressants, and antipsychotics. The prescribing patterns of psychiatrists, primary care clinicians, and all other physicians are compared. Differences in psychotropic prescribing patterns by psychiatric diagnosis are examined as well. The excessive use of minor tranquilizers, the continuing use of first-generation psychotropic medications (particularly minor tranquilizers), and the lack of concordance between diagnoses and prescribed psychotropic medications are discussed.

Comparing fact sheets and lectures to provide investigational drug information.

This article describes a study to evaluate the effectiveness of two methods (fact sheets and lectures) of providing investigational drug information.

Prescribing of psychotropics in elderly nursing home patients.

This study examined the prescribing of psychotropic drugs for patients 65 years of age and older in nursing homes using data from the 1984 National Nursing Home Survey pretest. The most frequently used antipsychotic, anxiolytic, antidepressant, and sedative/hypnotic medications were respectively: haloperidol, hydroxyzine, doxepin, and temazepam. Results indicate that more than one-fifth of the patients having orders for psychotropic medications did not have a documented mental disorder. More than one-fourth of the study patients had orders for more than one psychotropic medication. Nursing home patients who received psychotropics had concurrent orders for an average of 3.3 nonpsychotropic medications, many of which could increase the possibility of drug interactions and potential side effects.

Health services research in nursing homes: a systematic review of three clinical geriatric journals.

This article presents the results of a systematic review of five years of health services research found in nursing home studies published in three major geriatric journals. This review indicates that very little services research has been undertaken in nursing home settings. The small amount of quantitative, empirical research that has been published has suffered from research design, method, and analytic shortcomings. Nursing home research in at least one federal agency has experienced worse than average funding and disapproval rates. The implications of this review are discussed, and recommendations are made for advancing this important area of study.

Prescribing of psychotropic medication by primary care physicians and psychiatrists.

This study investigates the prescribing of psychotropic medications by primary care physicians and psychiatrists using the National Ambulatory Medical Care Survey database. Results indicate that primary care practitioners provide a larger percentage of psychotropic drug visits than psychiatrists in every psychotropic class except for those patients prescribed lithium. In addition, the two provider groups differed in the relative proportions of the classes of psychotropic drugs prescribed. Primary care physicians prescribed anxiolytics most frequently, while psychiatrists prescribed antidepressants most often. Finally, in all therapeutic classes, when a psychotropic medication was prescribed, psychiatrists typically provided a mental health diagnosis, while primary care physicians did not.

The use of mental health measures in nursing home research.

To examine the quality of mental health research in nursing homes, 130 articles published in six geriatric specialty and health care delivery journals were reviewed. Thirty-nine (30%) articles used a mental health measure. Measures of cognitive function were most common, being used in 32 (25%) of the articles reviewed. Twenty-three (18%) studies measured abnormal mental experiences and 17 (13%) articles measured behavioral disorder. Many articles used measures or determinations with no established reliability. Twenty-six of the articles which used a mental health measure also used a measure of activities of daily living or physical function. Retrospective and prospective studies were similar in number. A minority of articles used control groups, random samples, or prepost measures while a majority (64%) identified an outcome measure. We conclude that nursing home research can be improved by the increased use of reliable measures of cognition and abnormal mental experiences and by the development of reliable measures of behavioral disorder. Study design can be improved by identifying a priori hypotheses and by the increased use of random sampling and control/comparison groups.

Pharmacist patient education: what strategies work?

Previous research reveals that pharmacist-coordinated patient education programs have been effective only if they go beyond providing information to patients. Effective programs must include strategies that assist and encourage patients to incorporate this new information into their life styles.

Anticonvulsant serum levels are useful only if the physician appropriately uses them: an assessment of the impact of providing serum level data to physicians.

The ability to measure serum levels of anticonvulsants has been a significant advance in the treatment of epilepsy. This technique enables practitioners to monitor a patient's plasma concentration, to detect potential toxicity, and to assess compliance with the prescribed regimen. A retrospective study of 164 adults with epilepsy was conducted to evaluate how serum anticonvulsant determinations were used by physicians in their treatment of epilepsy. Results indicate that the availability of test results did not improve the degree of seizure control, nor did it diminish patient reports of toxicity. In 17% of therapeutic decisions, prescribers did not appear to use the blood levels appropriately in their therapeutic decision-making process. When physicians did appropriately utilize information from serum levels, the degree of seizure control improved significantly compared with when the prescribers did not use this information. The cost of determining serum levels of anticonvulsants is justified only if the information is appropriately utilized.

A drug self-administration program: a behavioral approach to patient education.

This study is an evaluation of an in-hospital patient education and drug self-administration program. The main goal of this patient education strategy was to increase appropriate drug use by patients after they were discharged from the hospital. Patients first learned about their medications from hospital staff, including pharmacists, and then gradually assumed the responsibility for self-administration of their drugs. Patients practices taking their medication while hospital staff monitored their actions, correcting inappropriate use and reinforcing correct use. Results showed that the program significantly increased both levels of drug knowledge and patient compliance when compared to a control group. An analysis of covariance revealed that improved compliance was attributable to both participation in the program and to the increase in drug knowledge. Patients were more satisfied with pharmacy services and perceived the pharmacist as being more knowledgeable about prescription drugs after interacting with pharmacists in this program. Analysis of patient locus of control revealed that internally oriented patients complied better after participating in the program than did externally oriented patients. In the control group, externally oriented patients complied better after receiving typical hospital care than did internally oriented patients. Thus, results imply that this behavioral approach benefited internally oriented patients.