Transcript Rate - The HRB Centre for Primary Care Research

HRB Centre for Primary Care Research
Department of General Practice
RCSI Medical School
Trends in psychostimulant
prescribing in Irish children
Udo Reulbach, Nicola Motterlini, Claire Keogh,
Kathleen Bennett and Tom Fahey
Overview
• HRB Centre for Primary Care Research
• Prescribing of medication in children
• Ongoing research with respect to psychotropic
medications
• Prevalence, core symptoms and diagnostic criteria
of Attention deficit hyperactivity disorder (ADHD)
• Clinical evidence for treatment
• Trends in psychostimulant prescribing
2
HRB Centre for Primary Care
Research
• Prescribing of medication is one of the most
common interventions that patients will experience.
• The quality and standard of drug prescribing and
the potential for medication error in patients is a
relevant public health concern.
• The HRB Centre for Primary Care Research is
interested in vulnerable groups particularly older
people, pregnant women, children and drug users
(Workpackage 1).
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Prescribing of medication in
children
• Antibiotics are the most commonly prescribed
drugs in children, representing one third of all
prescriptions in this population.
• High rates of antibiotic prescribing are an
increasing worldwide concern, in terms of
increased antimicrobial resistance and associated
burden to health services.
• Another trend is an increase in the prescription of
psycholeptics and psychoanaleptics in Children.
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Psychotropic medications
• Most of the psychotropic medications are
prescribed on an off-label basis. However, there is
still a lack of paediatric population-based
pharmacoepidemiological research.
• Study Design: A retrospective study (2002-2008) in
a national Irish population aged ≤ 15 years using
the Irish Primary Care Reimbursement Service
(HSE-PCRS) pharmacy claims database .
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Ongoing research
Analyses of off-label prescription and time trends in
prescribing of
•
•
•
•
•
•
Benzodiazepine related drugs
Benzodiazepine derivates
Antipsychotic medication
Antiepileptic drugs
Antidepressant medication
Psychostimulant drugs
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Attention deficit hyperactivity
disorder
• Prevalence estimates of attention deficit
hyperactivity disorder (ADHD) vary according to
the diagnostic criteria used and the population
sample:
• Among school children in US: 3-5%
• No objective tests exist to confirm the diagnosis of
ADHD (remains a clinical diagnosis)
• Formal diagnostic criteria are most applicable to
boys aged 6-12 years
Keen and Hadjikoumi, BMJ Clinical Evidence 2008;10:312
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Core symptoms and diagnostic
criteria of ADHD
• Inattention, hyperactivity and impulsiveness
• Other conditions frequently coexist with ADHD,
including developmental disorders and psychiatric
disorders (particularly oppositional defiant and
conduct disorder, anxiety and depressive
symptoms)
• Symptoms must be present for at least 6 months,
are generally observed in children before the age
of 7 years and cause clinically important
impairment
Keen and Hadjikoumi, BMJ Clinical Evidence 2008;10:312
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Clinical evidence
• Methylphenidate improves core symptoms.
• Dexamfetamine and atomoxetine may be also
beneficial. Atomoxetine may cause rare but serious
liver injury.
• Clonidine and modafinil may improve symptoms,
but are associated with an increased risk of
adverse effects
• Effectiveness of buproprion is unknown
• Long-term effectiveness of all psychostimulants is
unknown.
Keen and Hadjikoumi, BMJ Clinical Evidence 2008;10:312
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Prevalence of psychostimulant
prescriptions in Ireland (2002-2008)
Patient-based rate
Methylphendiate
ATC N06BA04
Dexamfetamine
ATC N06BA02
Modafinil
ATC N06BA07
Atomoxetine
ATC N06BA09
Age: 0-4 years
Age: 5-11 years
Age: 12-15 years
Rate
(95% CI)
0.342
(0.297-0.394)
0.031
(0.018-0.049)
0.002
(0.00004-0.010)
0.003
(0.0004-0.013)
Rate
(95% CI)
8.110
(7.914-8.309)
0.197
(0.168-0.230)
0.004
(0.001-0.011)
0.488
(0.441-0.538)
Rate
(95% CI)
9.209
(8.927-9.497)
0.086
(0.061-0.119)
0.023
(0.011-0.0419)
0.613
(0.541-0.690)
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Time trend of psychostimulant
prescriptions in Ireland (2002-2008)
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patients/GMS based on 1000 patients
12
10
8
6
Ma l e
4
Fema l
e
2
0
2002
2003
2004
2005
Year
2006
2007
2008
Time trend of psychostimulant
prescriptions in Ireland (2002-2008)
prescriptions/GMS based on 1000 patients
120
100
80
60
Ma l e
Fema l
e
40
20
0
2002
2003
2004
2005
Year
2006
2007
2008
Time trend of psychostimulant
prescriptions in Ireland (2002-2008)
10
9
prescriptions\patients
8
7
6
5
Ma l e
4
Fema l
e
3
2
1
0
2002
2003
2004
2005
Year
2006
2007
2008
Non-psychostimulant prescriptions
for ADHD in Ireland (2002-2008)
patients/GMS based on 1000 patients
0.25
0.2
0.15
N07BA02
0.1
N02CX02
0.05
0
2002
2003
2004
2005
2006
2007
2008
Year
14
Summary
• Methylphenidate is the main substance prescribed
for ADHD children in Ireland
• The prevalence of psychostimulant prescriptions is
increasing
• Further research required with respect to
– Male-dominated prescription patterns
– Co-medications
– Practive variations
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U.R., N.M. and C.K. are supported by the Health Research Board of Ireland
through the HRB Centre for Primary Care Research under Grant HRC/2007/1