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.

Improving the spontaneous reporting of suspected adverse drug reactions: An overview of systematic reviews.

AIM: To conduct an overview of systematic reviews examining interventions to stimulate spontaneous reporting of suspected adverse drug reactions (ADRs) by healthcare professionals (HCPs) and/or patients/carers. METHODS: Systematic reviews published since 1 January 2000 were identified and the included publications categorized in relation to the 4Es (education, engineering, economics and enforcement). RESULTS: Almost all studies were aimed at HCPs. Educational initiatives were most often used and, in most studies, were associated with improvements in quantity and/or quality of reports, at least in the short term. Lectures/presentations and regular reminders (eg, verbal or by e-mail) were the educational methods most often identified by systematic reviews. Engineering initiatives were also generally effective, including improving the availability of reporting forms, electronic ADR reporting, modification of reporting procedures/policies or the reporting form and assistance to complete the form. Evidence for the benefit of economic incentives (eg, monetary rewards, lottery tickets, days off work, "giveaways" and educational credits) was often clouded by the potential effects of other concomitant initiatives, and any possible associated improvements often disappeared rapidly after incentives were discontinued. CONCLUSION: Educational and engineering strategies appear to be the interventions most often associated with improvements in reporting rates by HCPs, at least in the short to medium term. However, the evidence for sustained impact is weak. The available data were insufficient to clearly identify the separate impact of economic strategies. Further work is also needed to examine the effects of these strategies on reporting by patients, carers and the public.