TY - JOUR
T1 - Association between antipsychotic polypharmacy and outcomes for people with serious mental illness in England
AU - Kasteridis, Panagiotis
AU - Ride, Jemimah
AU - Gutacker, Nils
AU - Aylott, Lauren
AU - Dare, Ceri
AU - Doran, Tim
AU - Gilbody, Simon
AU - Goddard, Maria
AU - Gravelle, Hugh
AU - Kendrick, Tony
AU - Mason, Anne
AU - Rice, Nigel
AU - Siddiqi, Najma
AU - Williams, Rachael
AU - Jacobs, Rowena
N1 - Funding Information:
This study was funded by the National Institute for Health Research, Health Services and Delivery Research Programme (project 13-54-40). Because of the sensitive and confidential nature of the data used for this analysis, and the permissions required to access it, the data set is not publicly available. The authors are grateful to the researchers who extracted and provided the Clinical Practice Research Datalink data. The authors thank all members of the scientific steering committee for their invaluable support and feedback. The multidisciplinary team responsible for this study included two patient representatives with serious mental illness, who contributed to the design of the research questions, the methodological approach, the interpretation of findings, and the drafting of the article. These views represent the opinions of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health. The authors report no financial relationships with commercial interests. Received November 7, 2018; revision received February 1, 2019; accepted March 21, 2019; published online May 21, 2019.
Publisher Copyright:
© 2019 American Psychiatric Association. All rights reserved.
PY - 2019/8
Y1 - 2019/8
N2 - Objective: Although U.K. and international guidelines recommend monotherapy, antipsychotic polypharmacy among patients with serious mental illness is common in clinical practice. However, empirical evidence on its effectiveness is scarce. Therefore, the authors estimated the effectiveness of antipsychotic polypharmacy relative to monotherapy in terms of health care utilization and mortality. Methods: Primary care data from Clinical Practice Research Datalink, hospital data from Hospital Episode Statistics, and mortality data from the Office of National Statistics were linked to compile a cohort of patients with serious mental illness in England from 2000 to 2014. The antipsychotic prescribing profile of 17,255 adults who had at least one antipsychotic drug record during the period of observation was constructed from primary care medication records. Survival analysis models were estimated to identify the effect of antipsychotic polypharmacy on the time to first occurrence of each of three outcomes: unplanned hospital admissions (all cause), emergency department (ED) visits, and mortality. Results: Relative to monotherapy, antipsychotic polypharmacy was not associated with increased risk of unplanned hospital admission (hazard ratio [HR]=1.14; 95% confidence interval [CI]=0.98–1.32), ED visit (HR=0.95; 95% CI=0.80–1.14), or death (HR=1.02; 95% CI=0.76–1.37). Relative to not receiving antipsychotic medication, monotherapy was associated with a reduced hazard of unplanned admissions to the hospital and ED visits, but it had no effect on mortality. Conclusions: The study results support current guidelines for antipsychotic monotherapy in routine clinical practice. However, they also suggest that when clinicians have deemed antipsychotic polypharmacy necessary, health care utilization and mortality are not affected.
AB - Objective: Although U.K. and international guidelines recommend monotherapy, antipsychotic polypharmacy among patients with serious mental illness is common in clinical practice. However, empirical evidence on its effectiveness is scarce. Therefore, the authors estimated the effectiveness of antipsychotic polypharmacy relative to monotherapy in terms of health care utilization and mortality. Methods: Primary care data from Clinical Practice Research Datalink, hospital data from Hospital Episode Statistics, and mortality data from the Office of National Statistics were linked to compile a cohort of patients with serious mental illness in England from 2000 to 2014. The antipsychotic prescribing profile of 17,255 adults who had at least one antipsychotic drug record during the period of observation was constructed from primary care medication records. Survival analysis models were estimated to identify the effect of antipsychotic polypharmacy on the time to first occurrence of each of three outcomes: unplanned hospital admissions (all cause), emergency department (ED) visits, and mortality. Results: Relative to monotherapy, antipsychotic polypharmacy was not associated with increased risk of unplanned hospital admission (hazard ratio [HR]=1.14; 95% confidence interval [CI]=0.98–1.32), ED visit (HR=0.95; 95% CI=0.80–1.14), or death (HR=1.02; 95% CI=0.76–1.37). Relative to not receiving antipsychotic medication, monotherapy was associated with a reduced hazard of unplanned admissions to the hospital and ED visits, but it had no effect on mortality. Conclusions: The study results support current guidelines for antipsychotic monotherapy in routine clinical practice. However, they also suggest that when clinicians have deemed antipsychotic polypharmacy necessary, health care utilization and mortality are not affected.
UR - http://www.scopus.com/inward/record.url?scp=85070848705&partnerID=8YFLogxK
U2 - 10.1176/appi.ps.201800504
DO - 10.1176/appi.ps.201800504
M3 - Article
C2 - 31109263
AN - SCOPUS:85070848705
SN - 1075-2730
VL - 70
SP - 650
EP - 656
JO - Psychiatric Services
JF - Psychiatric Services
IS - 8
ER -