Transcript Psychoactive Medications

UCI-RCOC
NEURODEVELOPMENTAL
PROGRAM AND CLINIC
A 14 Year Review
February 2, 2012
UCI Professional Personnel
Ira T. Lott, MD - Pediatric Neurologist and Director
Paul Touchette, EdD – Psychologist
Gail Fernandez, MD – Psychiatrist
Anne Tournay, MD – Neurologist
Larry Plon, Pharm D. - Research Pharmacist
Christy Hom, PhD - Neuropsychologist and Coordinator
Objectives
1) To determine the extent of
polypharmacy for psychoactive drugs in
the RCOC consumer population
2) Interdisciplinary Team Clinic for RCOC
consumers with medication and
behavioral issues
Psychoactive Drug Survey


30 months consecutive data
CalOptima Pharmacy Billing Records
Accessed

Cross-linked to RCOC consumers
30 month Medication Survey
7,419 psychoactive drug prescriptions for
RCOC population ( 26.8% of all prescriptions
written)


62% had more than one psychoactive drug
prescription and 32% had 3 or more

First study of its kind in the DD population,
published J Intellect Disability Research
30 Month Survey of
Psychoactive Medications

2,229,970 prescriptions surveyed


92,162 patients
25% were for psychoactive drugs
Is it possible to determine medication
adherence from the pharmacy billing records?

Calculation of Medication Adherence
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
Ratio =
# of days of drug supply
# of days from first to last refill
Adherence “yes” if ratio is ≥0.75 to 1.1

Adherence “no” if ratio<0.75
Adherence by Residence Type

Cross linked adherence calculations with
residence type from CDER
Number of Clients by Residence
Residence
Valid
Percent
Frequency
Cumulative
Percent
Own Home/
Parent/Guardian
749
32.5
32.6
Own Home/
Independent Living
140
6.1
38.7
Supported Living
113
4.9
43.6
11
.5
44.5
CCF (1-3)
4
.2
44.7
CCF (4-6)
725
31.5
76.2
CCF (7-15)
40
1.7
77.9
CCF (16-49)
79
3.4
81.3
4
.2
81.5
CCF (RCFE)
CCF (50+)
Total = 1865 RCOC Consumers
Psychoactive vs. Other Drug Types
Drug Type
Frequency
Percent of
all fills
Psychoactive
546046
24.5
Cardiac
135691
6.1
Antihypertensive
67872
3.0
Antilipemic
61718
2.8
Antidiabetic
35119
1.6
Clients in Own Home Significantly Less
Adherent for All 5 Medication Classes
Own Home vs. CCF
Chi-Square
Value p-value
Odds Ratio
(95% conf. interval)
Antidiabetic
4.04
0.04
6.58 (0.80-53.37)
Antilipemic
18.31
<0.00
7.29 (2.64-20.27)
Cardiac
5.51
0.02
2.98 (1.16- 7.62)
Blood pressure
18.69
<0.00
14.38 (3.19-65.31)
Psychoactive
Medications
116.5
<0.00
2.07 (1.81- 2.38)
Factors Affecting Medication
Adherence
Residence
Group home residents are twice as likely to adhere to
their psychoactive prescriptions than consumers who
live in their own home or family home

Medication form
Divalproex ER is 2.01 times more likely to be adhered
to than regular Divalproex


Polypharmacy, gender, and age did not affect
adherence.
Conclusions from Adherence Study

Medication adherence is problematic for clients
living in their own home

This is very similar to the general population

Public health efforts towards medication
adherence indicated
INTERDISCIPLINARY
CLINIC
Introduction to Interdisciplinary Clinic

Team consists of neurologist, psychiatrist,
educational, research and
neuropsychologists

All clients referred by RCOC
(1837 consumers evaluated since 1998)

Interdisciplinary team review of diagnostic,
medication, and treatment options for each
client
Primary Referral Reasons
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Polypharmacy
Medication side effects
Increasing behavioral problems

Need for diagnostic services
Mean Age of 1500 Consumers
Mean ages of consumers in years 2007-2011 less than in years 2001-2006; p<.001
Age Distribution of Clinic Population
Gender Distribution
Distribution from 2001-2004 significantly different than that from 2007-2011
Distribution in 2005 significantly different than that in 2006, but not from that in 2004
Distribution from 2010-2011 significantly different from 2007
Level of Intellectual Disability
Distribution of Intellectual Disability
*Prior to 2008, consumers with No Intellectual Disability had their ID Level coded as missing
% of Consumers with ID, Severity Unspecified has sharply increased since 2008
Number of Psychoactive
Medications Pre-Clinic
Average # of Psychoactive
Medications Pre-Clinic
Average # of medications from 2001-2007 greater than average # of
medications from 2008-2011; p<.001
Top 25 Medications Pre-Clinic
Major Psychiatric Diagnostic Categories
Diagnostic Trends by Year
Significant increase in consumers with an Anxiety Disorder or Autistic Disorder
Diagnostic Trends by Year
Significant decrease in consumers with Bipolar Disorder, OCD, or Impulse
Control Disorder
DIFFERENCES
BETWEEN DISORDERS
Associations with # of
Psychoactive Medications

Schizophrenia, Bipolar Disorder, and Impulse
Control Disorder associated with more
medications
Autistic Disorder associated with fewer
medications (possibly because younger in age)
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Associations with Schizophrenia
Significantly older than patients not diagnosed
with Schizophrenia

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Significantly higher intellectual functioning
Taking significantly more psychoactive
medications than those without Schizophrenia

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Significantly better personal, community, and
social skills than rest of clinic population
Associations with Bipolar Disorder


Taking significantly more psychoactive medications
than those without Bipolar Disorder

Caregivers less compliant in following clinic
recommendations

Significantly more irritable than consumers
without Bipolar Disorder
Significantly better personal, community, and social
skills than rest of clinic population
Associations with Autistic Disorder

Significantly younger than consumers without
Autism



Taking fewer psychoactive medications
Significantly less personal, community, and social
skills
Significantly more maladaptive behaviors (both
internalizing and externalizing behaviors)