Influence of socioeconomic status on antipsychotic prescriptions among youth in France.

BACKGROUND: Recent studies analysing the trends in antipsychotic (AP) prescriptions for children and adolescents have raised concerns regarding the influence of socioeconomic status. Previous findings have also shown variable prescription rates for first-generation (FG) and second-generation (SG) APs. METHOD: Our objectives were to assess the proportion of patients from low-income families receiving APs and the most commonly prescribed APs in France. We conducted a descriptive analysis of AP drugs dispensed during a 1-year period (July 1, 2013-June 30, 2014) in a northwestern region of France with 941,857 subjects less than 18 years old. All data were extracted from an exhaustive, individual and anonymous social security database. We obtained each subject's socioeconomic status (by identifying their affiliation with a specific social security program) and also collected sociodemographic data, drug type, prescribing and dispensing dates and amount, and prescriber type (e.g., hospital physician, general practitioner, psychiatrist, paediatrician). RESULTS: There were two main novel findings. First, we found that the proportion of patients with AP prescriptions was nearly ten times higher in low-income families than in the general population: 35.9% of CMU-C patients compared to 3.7% in all of Pays de la Loire (X 2 = 7875.1, p < 0.001). Additionally, we found a higher rate of FGAP than SGAP prescriptions (65% vs. 57%). CONCLUSIONS: Our study suggests two types of AP misuse that could provide interesting targets for public healthcare interventions. First, our results strongly suggest an over-representation of patients from low-income families. Low-income families primarily resided in areas with low physician density and appeared to receive drugs to treat their conditions more frequently than other individuals. This increased prescription rate is a public health issue, potentially requiring political action. Second, the use of FGAPs did not adhere to the latest recommendations for drug use in this population, and this discrepancy should be addressed with informational campaigns targeted to medical practitioners.

[Disclosing harmful adverse event: Assessment of medical practices from clinical vignettes]. / Annonce d'un événement indésirable grave associé aux soins au patient : évaluation des pratiques médicales à partir de vignettes cliniques.

The French National Authority for Health has made serious adverse event disclosure one of its priority areas of work. The objective of the study was to explore clinicians' perceived practices of disclosing such events. Between June and July 2012, a structured questionnaire was emailed to all clinicians and residents working at the Nantes Teaching Hospital. The questionnaire consisted of 3 parts first, clinical vignettes-with medical and surgical cases exploring five areas of practices (initial disclosure, disclosure of details, disclosure of the cause, apologies, and patient information about preventive actions); second, questions about the reasons for disclosure or non-disclosure; third, an evaluation of the training needs. The overall response rate was 18.8% (n=322/1709). Clinicians did not realize initial disclosure in 13.4%, disclosure of details in 24.5%, disclosure of the cause in 44.1%. Of the respondants, 4% of them would not apologize and 11.2% of them would not discuss detailed plans for preventing recurrences. Results were significantly different between medical and surgical specialities concerning disclosure of details and the cause of adverse events: surgeons were significantly less inclined than physicians to volunteer any details unless asked by the patient (72.9% vs 16.1%; P<0.001); to disclose the cause of the events (54.2% vs 42.3%, P<0.001); and to apologize or to offer an expression of regret (16.7% vs 1.8%; P<0.001). The main reason that led respondents to disclose as well as not disclose was to maintain trust in their relationship with the patient. Younger clinicians expressed more difficulties with adverse event disclosure and had more important training needs. Based on these results, an improvement program for the disclosure of serious adverse events is currently being implemented in the hospital, consisting of training sessions, documentation and support for the clinicians.