Reason for discontinuation of newly prescribed antihypertensive medications: methods of a pilot study using computerized patient records.

Objective-The purpose of this pilot study was to examine the feasibility of using computerized medical records retrospectively to identify patients and their physicians for subsequent survey to examine discontinuation of a newly prescribed antihypertensive medication in primary care, while maintaining patient confidentiality.Design-A case - control study utilizing UKPCD (formerly MediPlus(R)), a large automated database of computerized medical records, and direct collection of information from patients and their physicians.Setting-Eight selected general practices in the United Kingdom.Participants-Thirty-two patients, identified with a newly prescribed antihypertensive (index) medication and classified by their treatment status (discontinuer vs continuer) and five physicians were surveyed.Results-The participation rate was low among physicians (19%), likely to be due to recruitment during the holiday season, but higher among eligible patients (70%). A higher proportion of discontinuers (37%) refused or failed to respond to the invitation to participate compared with continuers (27%). For most patients, self-reported treatment status matched the UKPCD-based classification of discontinuer or continuer (kappa = 0.67); agreement of UKPCD data with physicians was moderate (kappa = 0.53). The extent and accuracy of the information collected from patients demonstrated that they were able and willing to report detailed knowledge of their medications and recent symptoms. Discontinuers, however, had difficulty recalling the discontinued medication on their own, possibly due to the amount of time elapsed between the event and the questionnaire administration.Conclusion-This pilot study demonstrates the feasibility of examining medication discontinuation in an ambulatory setting by utilizing a large automated database of computerized records to identify and recruit eligible physicians and their hypertensive patients for study, while maintaining patient and physician privacy. Modifications to the methodology to increase physician and patient participation and recall, and to decrease the time between the index event and patient query would increase its utility in larger studies. Copyright (c) 2000 John Wiley & Sons, Ltd.

Clinical and treatment characteristics of children with attention-deficit/hyperactivity disorder in psychiatric practice.

OBJECTIVE: To capture information about the clinical characteristics of, and treatments for, children with attention-deficit/hyperactivity disorder (ADHD) in psychiatric practice. METHOD: A mailed, self-administered questionnaire was sent to 81 practicing psychiatrists for them to complete on the next three consecutive patients aged 14 years and younger with ADHD seen during the 12-day study period. Information collected included the sociodemographic, clinical, and treatment characteristics of sampled patients. RESULTS: Patients in the study were predominantly white (85%), male (78%), and between 10 and 14 years old (58%). The most common ADHD subtype was combined/predominantly hyperactive (86%); 31% had no other comorbidity. Ninety-seven percent were receiving medications, with 49% receiving two or more. The single most common medication reported was methylphenidate (51% of patients) followed by clonidine (20%). Psychotropics other than psychostimulants were used in a majority of patients (55%). CONCLUSIONS: Psychiatrists, and child and adolescent psychiatrists in particular, see a more severely impaired and complex group of patients than would be expected of primary care providers. The treatment patterns of psychiatrists for these patients do not reflect the simpler treatments usually studied in clinical trials.

Characterizing psychiatry with findings from the 1996 National Survey of Psychiatric Practice.

OBJECTIVE: The authors' goal was to characterize psychiatric practice by reporting findings from the 1996 National Survey of Psychiatric Practice. METHODS: A random sample of 1,481 APA members was selected to participate in the study; 1,375 APA members were determined to be eligible for study participation. The authors report data from 970 respondents (70.5% response rate) and compare them with data from previous surveys of psychiatrists. RESULTS: Twenty-five percent of the participating psychiatrists were women, compared with 19% in a 1988-1989 survey. Since 1988-1989, the proportion of psychiatrists 39 years old or younger has decreased and the proportion of those 55 years old or older has increased. In 1996, psychiatrists saw, on average, 35.4 unduplicated patients and worked an average of 46.4 hours in a typical week. Patients with mood disorders as their primary diagnoses accounted for the greatest proportion of psychiatrists' caseloads, followed by patients with anxiety disorders, then those with schizophrenia and other psychotic disorders. Public sources of payment and uncompensated care were the main sources of payment for psychiatrists services for 41.7% of patients. The primary payment mechanism for psychiatrists' patient care services was fee-for-service, accounting for 52.5% of psychiatrists' income from direct patient care. Twenty-nine percent of psychiatric patients received care through some form of managed care system, and 41.6% received treatment through a nonmanaged public or private health plan. CONCLUSIONS: As psychiatry moves into the next century, findings from the National Survey of Psychiatric Practice will form a baseline for monitoring changes and trends in the delivery and financing of mental health services.