Antidepressant prescribing patterns and adverse events following introduction of a National Prescribing Indicator to monitor dosulepin usage in Wales.

AIMS: Limiting use of the antidepressant dosulepin has been encouraged due to associated risks of toxicity. In April 2011, the All Wales Medicines Strategy Group introduced a National Prescribing Indicator (NPI) to monitor dosulepin usage. The aim of this study was to investigate antidepressant prescribing patterns, and selected adverse events in patients prescribed dosulepin following introduction of the NPI. METHODS: An e-cohort study was conducted. Adult patients receiving regular dosulepin prescriptions between October 2010 and March 2011 were included. Characteristics of patients who were continued on dosulepin, were switched to an alternative antidepressant or whose dosulepin was discontinued following introduction of the NPI were compared. RESULTS: In total, 4121 patients were included. Of these, 1947 (47%) continued dosulepin, 1487 (36%) were switched and 692 (17%) discontinued. Of the 692 who discontinued, 92% did not receive a prescription for another antidepressant during the follow-up period. Patients whose dosulepin was discontinued were older and were less commonly coprescribed benzodiazepines. During follow-up, recorded incidence of selected adverse events was low across all groups and no significant difference was observed. CONCLUSION: Over half of patients had discontinued dosulepin at the end of the period when the NPI was in place. Further interventions may have been required to have a greater impact on prescribing. This study provides some reassurance that dosulepin discontinuation can be a successful strategy, and that the risk of the adverse events investigated was unlikely to have been greater in those who had dosulepin discontinued than in those in whom dosulepin had been continued.

Changes in suspected adverse drug reaction reporting via the yellow card scheme in Wales following the introduction of a National Reporting Indicator.

AIMS: This study aimed to assess the impact of a National Reporting Indicator (NRI) on rates of reporting of suspected adverse drug reactions using the Yellow Card scheme following the introduction of the NRI in Wales (UK) in April 2014. METHODS: Yellow Card reporting data for general practitioners and other reporting groups in Wales and England for the financial years 2014-15 (study period 1) and 2015-16 (study period 2) were obtained from the Medicines and Healthcare Products Regulatory Agency and compared with those for 2013-14 (pre-NRI control period). RESULTS: The numbers of Yellow Cards submitted by general practitioners in Wales were 271, 665 and 870 in the control period, study period 1 and study period 2, respectively. This is equivalent to an increase of 145% in study period 1 and 221% in study period 2 compared with the 12-month control period (2013-14). Corresponding increases in England were 17% and 37%, respectively (P < .001 chi-squared test). The numbers of Yellow Cards submitted by other groups in Wales were 906, 795 and 947 in each of the study periods. CONCLUSIONS: Introduction of the NRI corresponded with a significant increase in the number of Yellow Cards submitted by general practitioners in Wales. General practitioner reporting rates continued to increase year on year through to 2018-19 with the NRI still in place. No concomitant change was found in reporting rates by other groups in the health boards in Wales.

Estimated Versus Observed Expenditure Associated with Medicines Recommended by the All Wales Medicines Strategy Group.

OBJECTIVES: The All Wales Medicines Strategy Group (AWMSG) appraises the clinical and cost effectiveness of new medicines being considered for National Health Service (NHS) prescribing in Wales (UK). The aim of this study was to compare the estimated expenditure on selected medicines submitted by pharmaceutical companies for appraisal with the observed expenditure on these medicines following recommendation. METHODS: Medicines appraised and recommended for use in NHS Wales by AWMSG between May 2005 and December 2013 were identified for inclusion in the study. Estimates of expenditure were obtained from company submissions to AWMSG. Primary and secondary care dispensing databases were used to obtain observed expenditure. The Wilcoxon matched-pairs signed rank test was used to compare the observed and estimated expenditure in each of the 3 years after introduction of the medicine. RESULTS: Forty-nine medicines appraised and recommended by AWMSG during the period of interest were included in the study. Median estimated and observed expenditure in each of the 3 years post-recommendation were as follows: year 1 £86,400 and £47,300; year 2 £175,500 and £73,200; year 3 £212,100 and £78,900 (p = 0.03, p = 0.006 and p = 0.001, respectively). The expenditure on 42 of the 49 medicines (82%) was overestimated in at least one of the 3 years post-introduction, with 32 (65%) overestimated in all 3 years. CONCLUSION: In their applications for health technology appraisal, pharmaceutical companies tended to overestimate the expenditure of the majority of medicines recommended by AWMSG. These findings have implications for the assessment of predicted expenditure as part of the process of medicines appraisal in Wales.

An exploratory study of the patient experience of pharmacist supplementary prescribing in a secondary care mental health setting.

BACKGROUND: Management of chronic disease has become an increasing challenge to the National Health Service in the United Kingdom. The introduction of supplementary prescribing was seen as a possible mechanism to address the needs of this patient group. Individuals with mental illness were considered particularly suitable for management in this way. OBJECTIVE: To explore the views and experiences of patients with mental illness on being managed by a pharmacist supplementary prescriber in a secondary care outpatient setting. METHODS: A study of patient experiences utilising semi-structured interviews and self-completion diaries was adopted. Eleven patients participated in the study. Data were analysed utilising code and retrieve, and content analysis respectively. RESULTS: Patients valued the increased accessibility to, and continuity of, their prescriber compared with their experience of other healthcare professionals. Patients reported they were able to trust the pharmacist's knowledge of medication, were provided with sufficient information regarding reasons for treatment and side effects, and felt that they had an active role in decisions concerning their healthcare. CONCLUSIONS: This exploratory study showed that patients had positive views of being managed by a supplementary prescriber. However, it should be noted that the number of participants was small. It is therefore important that further, more wide ranging research is conducted to evaluate pharmacist prescribing within mental health settings.

An exploratory study of the patient experience of pharmacist supplementary prescribing in a secondary care mental health setting / Estudio exploratorio de la experiencia de los pacientes sobre la prescripción farmacéutica suplementaria en una clínica secundaria de salud mental

Background: Management of chronic disease has become an increasing challenge to the National Health Service in the United Kingdom. The introduction of supplementary prescribing was seen as a possible mechanism to address the needs of this patient group. Individuals with mental illness were considered particularly suitable for management in this way. Objective: To explore the views and experiences of patients with mental illness on being managed by a pharmacist supplementary prescriber in a secondary care outpatient setting. Methods: A study of patient experiences utilising semi-structured interviews and self-completion diaries was adopted. Eleven patients participated in the study. Data were analysed utilising code and retrieve, and content analysis respectively. Results: Patients valued the increased accessibility to, and continuity of, their prescriber compared with their experience of other healthcare professionals. Patients reported they were able to trust the pharmacist’s knowledge of medication, were provided with sufficient information regarding reasons for treatment and side effects, and felt that they had an active role in decisions concerning their healthcare. Conclusions: This exploratory study showed that patients had positive views of being managed by a supplementary prescriber. However, it should be noted that the number of participants was small. It is therefore important that further, more wide ranging research is conducted to evaluate pharmacist prescribing within mental health settings (AU)

Antecedentes: El manejo de las enfermedades crónicas se ha convertido en un reto para el Sistema Nacional de Salud del Reino Unido. La introducción dela prescripción suplementaria fue vista como un mecanismo para afrontar las necesidades de este grupo de pacientes. Los individuos con problemas de salud mental fueron considerados particularmente apropiados para teste tipo de manejo. Objetivo: Explorar las visiones y experiencias de los pacientes con salud mental al ser manejados por un farmacéutico prescriptor suplementario en una clínica ambulatoria de cuidaos secundarios. Métodos: Se adoptó un estudio de las experiencias de los pacientes utilizando entrevistas semiestructuradas y diarios auto-cumplimentados. Once pacientes participaron en el estudio. Los datos se analizaron usando codificación y recuperación, y un análisis de contenido respectivamente. Resultados: Los pacientes valorizaron el aumento de accesibilidad y la continuidad de su prescriptor comparado con otros profesionales de la salud. Los pacientes comunicaron que eran capaces de confiar en los conocimientos sobre medicación del farmacéutico, que les proporcionaba con suficiente información sobre los motivos de su tratamiento y efectos adversos, y sentían que tenían un papel activo en las decisiones sobre su salud. Concusiones: Este estudio exploratorio mostró que los pacientes tenían visiones positivas al ser manejados por un prescriptor suplementario. Sin embargo, debe reconocerse que el número de participantes fue pequeño. Por ello es importante que se realice más investigación y más amplia para evaluar la prescripción farmacéutica en las clínicas de salud mental (AU)

Risperidone long acting injection: Findings of a 2-year retrospective follow-up study.

Objective. The aim of this retrospective study was to assess the clinical effectiveness of risperidone long acting injection (RLAI) at 2 years within an acute mental health setting. Method. All patients who received RLAI between July 2002 and December 2004 were identified from pharmacy records, and data collected by retrospective case note review. In order to give an indication that their condition was unresponsive to treatment, patients' drug histories were reviewed to determine whether or not they had previously been treated with clozapine or received two or more failed trials of other antipsychotic medication. Results. Eighty-four patients were included in the study and 56 discontinued at 2 years. The most common reason for treatment discontinuation was lack of effectiveness, accounting for 32 patients, whilst eight patients discontinued due to adverse effects. Patients remaining on treatment spent 67% of the time in an outpatient setting. Conclusion. The proportion of patients remaining on RLAI at 2 years was 33%. Limitations of the naturalistic methodology used in this study hindered any precise determination of which patients were likely to continue RLAI. However, it was apparent that a history of previous treatment failure with at least two antipsychotics was associated with RLAI treatment discontinuation.

Aripiprazole: 6-month outcomes in a retrospective naturalistic study.

Aim. The efficacy of aripiprazole has been demonstrated in randomised controlled trials, but due to inclusion and exclusion criteria, these may not be representative of clinical practice. The aim of this naturalistic study was to investigate patients from an acute mental health trust who received aripiprazole, using treatment discontinuation as a primary outcome measure. Method. All patients with schizophrenia or schizoaffective disorder who had received aripiprazole were identified from pharmacy records, and data collected by retrospective case note review. Results. Seventy subjects were included in the study. A total of 28 (40%, n=70) patients remained on aripiprazole monotherapy at 6 months. The most common reason for discontinuation was lack of effect, seen in 29 patients; only 12 patients discontinued due to adverse effects. Thirty-five percent of the subjects had previously been treated with clozapine, although this did not appear to influence outcome. Conclusion. Despite limitations of the naturalistic methodology used in this study, it appears that aripiprazole is relatively well tolerated, and effective in clinical practice. The 40% continuation rate seen with aripiprazole is comparable to that seen with risperidone, quetiapine, and perphenazine in the CATIE study at 6 months.

Experience with risperidone long-acting injection: results of a naturalistic observation study.

Typical antipsychotics are effective in the management of schizophrenia, but are associated with troublesome adverse effects which may lead to treatment discontinuation and relapse. Long-acting depot formulations of these drugs improve patient compliance, but do not reduce the incidence of adverse effects. There is evidence to suggest that newer atypical antipsychotic drugs have a reduced propensity to induce movement disorders and are associated with a modest reduction in relapse rates. The introduction of risperidone long-acting injection (RLAI) provided clinicians with the first long-acting formulation of an atypical antipsychotic. Objective. The aim of this study was to investigate the outcomes of patients from an acute mental health trust who received RLAI during the 18-month period following its licensing in the UK in order to examine measures of clinical effectiveness, and reasons for treatment discontinuation. Methods. Data were collected retrospectively from medical notes. Results. Fifty-nine patients were included in the study, and at the time of data collection 32 (54%) had discontinued treatment. The most common reason for discontinuation was lack of effectiveness, although all of the patients who discontinued due to lack of response were treatment resistant. RLAI appeared to be well tolerated, with only 12% of patients discontinuing due to adverse effects. Thirty-eight percent of the patients treated with RLAI showed a good response as measured by discharge from inpatient setting, and of the 22 outpatients at time of data collection, five had one re-hospitalisation during the study period. Conclusion. This study concludes that RLAI appears to be well tolerated, and shows some effectiveness in the treatment of schizophrenia, but may not be effective for patients who are treatment resistant.

Morphine, cocaine and antidepressant induced motivational activity and midbrain dopaminergic neurotransmission.

Positive motivational properties of opioids, stimulants and serotonin selective reuptake inhibitors have been reported following place preference conditioning. The possibility that these effects are associated with changes in dopamine concentration in the nucleus accumbens or striatum was investigated. Male Wistar rats were place conditioned in a three compartment model to vehicle or drug (morphine 2.5 mg/kg, cocaine 5 mg/kg, sertraline 5 mg/kg or paroxetine 15 mg/kg) alternately for 8 days using a 30 min pre-treatment time. Control animals received saline only. Nucleus accumbens and striatal tissue were dissected 72 h after final drug dose, and the concentration of dopamine and its metabolites determined using high performance liquid chromatography (HPLC). Striatal dopamine D1-like receptor density was also determined through radioligand binding. Significant place preference (P<0.05) was observed with morphine, cocaine and sertraline. Morphine treated subjects showed a significant decrease (P<0.05) in striatal dopamine concentration, whilst cocaine and sertraline treatment resulted in a significant increase in striatal dopamine levels. Nucleus accumbens concentrations of dopamine, and striatal dopamine D1-like receptor density remained unchanged. The changes in striatal dopamine concentrations are consistent with withdrawal from opioid and stimulant compounds, and suggest that place preference conditioning may, in part, result from negative motivational or aversive effects.