Exploring Factors for Regional Differences in Inappropriate Psychotropic Drug Prescribing: Ecological Study Using a Claims Database in Japan

Speaker(s)

Fujisawa M1, Takashi N1, Ohtera S2
1National Center for Geriatrics and Gerontology, Obu, 23, Japan, 2Graduate School of Medicine Kyoto University, Obu, 23, Japan

Presentation Documents

OBJECTIVES: Inappropriate prescribing of psychotropic drugs, such as multiple prescriptions, is problematic in terms of adverse events and efficacy. Cognitive behavioral therapy (CBT) can reduce psychotropic drug prescriptions. However, Japan has a significant regional difference in its diffusion. We explored regional characteristics, including the number of prescriptions for CBT, to be associated with psychotropic prescriptions.

METHODS: The National Database of Health Insurance Claims (NDB) Open data in 2020 were used. We calculated Standardized Claim Ratio (SCR) of outpatient prescriptions in benzodiazepine hypnotic, anxiolytic, antidepressant, antipsychotics, and cognitive behavioral therapy by Japan 47 prefectures. To adjust for healthcare accessibility, SCR was normalized by the number of psychiatric and psychosomatic medical facilities per 100,000 residents in each prefecture. We divided the 47 prefectures into three groups by tertile of SCR for Cognitive Behavioral Therapy. Supply-adjusted SCRs of various psychotropic drugs were then compared between these groups. In addition, we divided the number of nursing homes population 65 years and older by prefecture into three quintiles and similarly compared the SCRs for each psychotropic drug.

RESULTS: The maximum to minimum SCRs ratios were 2.2 for hypnosis, 2.3 for anxiolytic, 1.79 for antidepressants, 2.3 for typical antipsychotics, 2.3 for atypical antipsychotics, and 329 for cognitive behavioral therapy. Antidepressant prescriptions tended to be more prevalent in moderate (M) than in low (L) prevalence of cognitive behavioral therapy (1.4 [0.04, 2.7] L-M). The same trend was observed for typical antipsychotics (2.2 [0.82, 3.6] L-M). The more nursing homes per 100,000 population 65 years and older tended to have fewer hypnotic prescriptions (-39 [-61, -18] L-M; -43 [-64, -22] L-H).

CONCLUSIONS: Cognitive behavioral therapy is unlikely to be a factor in reducing multiple prescriptions of psychotropic medications. There may be a cooperative effort to reduce psychotropic prescriptions in areas where nursing homes are clustered in the community.

Code

HSD59

Topic

Health Policy & Regulatory

Topic Subcategory

Health Disparities & Equity

Disease

Drugs, Geriatrics, Mental Health (including addition), Neurological Disorders