3137 — Increased off-label prescribing of psychotropic medications in VHA patients with dementia relative to those without, FY2012

Bowersox NW, SMITREC; Grindle C, SMITREC;

Objectives:
Psychotropic drug prescribing to patients with dementia has been a topic of interest due to concerns about negative care consequences associated with guideline discordant prescribing. The extent to which patients with dementia in the Veterans Health Administration (VHA) are prescribed psychotropic medications in a manner that does not match recommendations has not been evaluated in a systematic manner. Information related to this topic could be useful in informing for VHA patients with dementia.

Methods:
Using data from the National Patient Care Database we identified all VHA patients who received a dementia diagnosis during FY2012. A comparison cohort was created through age and gender matching. Information was collected related to psychotropic prescriptions and mental health diagnoses in FY2012. Each patient's psychotropic drug class fills were compared to mental health diagnoses. Patients were considered to have received an "off label" prescription if they had a mental health diagnosis not normally associated with the approved use of the medication, or to have received a "without mental health diagnosis" prescription if they received a prescription without any mental health diagnosis other than dementia during FY2012.

Results:
153,701 patients had at least one dementia diagnosis during FY2012, and 153,701 non-dementia patients were included in the matched comparison group. Among patients who received psychotropics, those with dementia were more likely to not have indicated mental health diagnoses for the medications (off-label use; antidepressants: 48.5% vs. 42.7%; mood stabilizers: 24.4% vs. 20.3%; antipsychotics: 23.1% vs. 8.0%; benzodiazepines: 17.6% vs. 16.2%) and more likely to have no documented mental health diagnosis (among those who received antidepressants: 20.7% vs. 6.7%; mood stabilizers: 9.8% vs. 6.9%; antipsychotics: 9.7% vs. 0.9%; and benzodiazepines: 7.3% vs. 4.0%).

Implications:
Patients with dementia were more likely to receive off-label prescriptions and prescriptions without any mental health diagnosis. This raises concerns related to potential overuse of pharmacological interventions in this group as well as potential underdetection/underdiagnosis of mental health conditions.

Impacts:
This information has the potential to improve care for VHA patients with dementia by raising awareness of overprescribing and underdetection in providers and inform the creation of guidelines to address these care concerns.