Titre du document / Document title

Physician and patient factors associated with the prescribing of medications for sleep difficulties that are associated with high abuse potential or are expensive : An analysis of data from the national ambulatory medical care survey for 1996-2001

Auteur(s) / Author(s)

RASU Rafia S. ⁽¹⁾ ; SHENOLIKAR Rahul A. ⁽²⁾ ; NAHATA Milap C. ⁽²⁾ ; BALKRISHNAN Rajesh ⁽²⁾ ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

⁽¹⁾ Division of Pharmacy Practice, University of Missouri-Kansas City School of Pharmacy, Kansas City, Missouri, ETATS-UNIS
⁽²⁾ Division of Pharmacy Practice and Administration, Ohio State University College of Pharmacy, Columbus, Ohio, ETATS-UNIS

Résumé / Abstract

Objective: This study evaluated the association between various socioeconomic and clinical factors relating to patients and physicians and the prescribing of medications that have a high abuse potential or are expensive for the treatment of sleep difficulties in a nationally representative sample of outpatient physician visits in the United States. Methods: This cross-sectional study used data from the National Ambulatory Medical Care Survey from 1996-2001. Patients aged ≥18 years who received treatment for sleep difficulties in US outpatient settings over this period were included in the study sample. Office visits were considered related to insomnia/sleep difficulties if relevant International Classification of Diseases, Ninth Revision, diagnosis codes were recorded and if insomnia was reported as the reason for the visit or any medication with a primary indication for insomnia was prescribed. Medications associated with dependence and withdrawal symptoms were categorized as having a high abuse potential. Medications were considered expensive if the average wholesale price of 100 tablets was ≥$150 (ie, the 75th percentile of the total cost of all medications prescribed for sleep disorders only). The data were subjected to multivariate logistic regression analysis. Results: From 1996 through 2001, 2966 unweight-ed patient visits for insomnia/sleep difficulty were identified, representing -94.6 million weighted observations in the overall US population; pharmacotherapy only was prescribed at 48% (45 million) of these visits. Medications with abuse potential were prescribed at 53% (24 million) of visits. Among visits at which pharmacotherapy was prescribed, visits by male patients were 39% less likely than visits by female patients to result in a prescription for a medication with abuse potential (odds ratio [OR] = 0.61; 95% CI, 0.45-0.81). Visits by patients with psychiatric comorbidities were 80% more likely to be associated with receipt of a prescription for a medication with abuse potential than were visits by patients with no such comorbidities (OR = 1.80; 95% CI, 1.31-2.47). Expensive medications were prescribed at 25% (15 million) of visits involving some pharmacotherapy. Patients aged ≥65 years were 44% less likely to receive a prescription for an expensive medication than was the reference group, patients aged 18 to 34 years (OR = 0.56; 95% CI, 0.35-0.90). Hispanic patients were 56% less likely to receive a prescription for an expensive medication than were non-Hispanic patients (OR = 0.44; 95% CI, 0.22-0.88). Conclusions: This study found an increased probability of female patients with sleep difficulties receiving a medication with high abuse potential in outpatient settings in the United States from 1996 through 2001. In addition, there was a possible association between the age and ethnicity of patients with insomnia/ sleep difficulties and the prescribing of expensive medications for sleep difficulties.

Revue / Journal Title

Clinical therapeutics   ISSN 0149-2918 

Source / Source

2005, vol. 27, n^o12, pp. 1970-1979 [10 page(s) (article)] (47 ref.)

Langue / Language

Anglais

Editeur / Publisher

Excerpta Medica, Belle Mead, NJ, ETATS-UNIS  (1977) (Revue)

Mots-clés anglais / English Keywords

Neurological disorder ; Nervous system diseases ; Sleep wake cycle ; America ; North America ; Economic aspect ; Public health ; Health economy ; Costs ; United States ; Chemotherapy ; Treatment ; Initiation ; Sleep disorder ; Survey ; Care ; Medicine ; Ambulatory ; Data analysis ; Abuse ; Sleep ; Drug ; Medical prescription ; Human ; Health staff ; Physician ;

Mots-clés français / French Keywords

Trouble neurologique ; Système nerveux pathologie ; Cycle veille sommeil ; Amérique ; Amérique du Nord ; Aspect économique ; Santé publique ; Economie santé ; Coût ; Etats Unis ; Chimiothérapie ; Traitement ; Initiation ; Trouble sommeil ; Enquête ; Soin ; Médecine ; Ambulatoire ; Analyse donnée ; Abus ; Sommeil ; Médicament ; Prescription médicale ; Homme ; Personnel sanitaire ; Médecin ;

Mots-clés espagnols / Spanish Keywords

Trastorno neurológico ; Sistema nervioso patología ; Ciclo sueño vigilia ; America ; America del norte ; Aspecto económico ; Salud pública ; Economía salud ; Coste ; Estados Unidos ; Quimioterapia ; Tratamiento ; Iniciación ; Trastorno sueño ; Encuesta ; Cuidado ; Medicina ; Ambulatorio ; Análisis datos ; Abuso ; Sueño ; Medicamento ; Prescripción médica ; Hombre ; Personal sanitario ; Médico ;

Mots-clés d'auteur / Author Keywords

sleep initiation/maintenance disorders ; therapy ; ambulatory care ; drug therapy ; United States ; costs ;

Localisation / Location

INIST-CNRS, Cote INIST : 18353, 35400011513737.0120