(136) Antipsychotic Utilisation Within Primary Care in England from 2010-2020

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 810

Presenting Author(s)

Fatema Mahmoud
– University of Strathclyde, University of Strathclyde , Glasgow, Scotland, G1 1XQ, United Kingdom

Co-Author(s)

Amy Pavis
– University of Strathclyde, Edinburgh, Midlothian, United Kingdom
Amanj Kurdi, PhD
– Lecturer in Pharmacoepidemiology and Pharmacy Practice, University of Strathclyde, Glasgow, United Kingdom

Background: England has seen small rises in psychotic symptoms, while antipsychotic medication use has almost doubled. Research on the influence of UK National Institute for Health and Care Excellence (NICE) guidelines on antipsychotic prescribing is equivocal. Other specialist guidance is available (Scottish Intercollegiate Guidelines Network (SIGN), The Maudsley, Schizophrenia Patient Outcome Research Team (SPORT), and Psychotropic Drug Directory (PDD)) but no existing research considers the influence of specialist guidance on primary care prescribing trends.

Objectives: To examine and evaluate England’s antipsychotic prescribing trends, using latest available data to assess the potential relationship to NICE and specialist guidance.

Methods: This repeated retrospective cross-sectional study used English Prescription Cost Analysis datasets from 2010-2020 which covers all antipsychotic dispensing in the community setting. Utilisation was measured in number of items dispensed/1000 inhabitants and DDDs/1000 inhabitants/day. Analysis was conducted using descriptive statistics (absolute and relative percentage changes) and linear regression assessed the significance of average annual change.

Results: In 2010, 143.9 antipsychotic items were dispensed/1000 inhabitants, increasing to 203.5 by 2020 (a relative increase of 41%, and a 24% rise based on DDDs). This consisted of a 66% increase in the number of items dispensed for atypical antipsychotics (46% increase for DDDs) and a decrease in typicals (-35% for number of items, -41% for DDDs). Atypicals represented 88% of antipsychotics dispensed in 2020 (DDDs). The top five antipsychotics dispensed were Quetiapine, Olanzapine, Risperidone, Aripiprazole and Amisulpride.

Conclusions: Increases in antipsychotic prescribing are accounted for by increased atypical use. The increasing popularity of atypical antipsychotics (specifically the top five antipsychotics) does not reflect generic NICE recommendations but does follow other specialist guidance. This may reflect higher levels of antipsychotic prescribing being initiated in secondary care and indicate a need for national guidelines to include hierarchies of efficacy, tolerability/side-effects for individual antipsychotics that would better inform patient and prescriber decision making in primary care.