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Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015
Author(s) -
Rhee Taeho Greg,
Rosenheck Robert A.
Publication year - 2019
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.13072
Subject(s) - medicine , medical prescription , logistic regression , odds , psychiatry , odds ratio , ambulatory , psychotropic drug , ambulatory care , health care , drug , economics , pharmacology , economic growth
Objectives To estimate rates and national trends of initiation of new psychotropic medications without a psychiatric diagnosis and to identify demographic and clinical correlates independently associated with such use among US adults in outpatient settings. Data Source Data were gathered from the 2006‐2015 National Ambulatory Medical Care Survey ( NAMCS ), a nationally representative sample of office‐based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n = 8618 unweighted). Study Design Using a repeated cross‐sectional design with survey sampling techniques, we estimated prescription initiation rates and national trends. Multivariable‐adjusted logistic regression analysis was used to identify correlates independently associated with initiation of new psychotropic prescriptions without a psychiatric diagnosis. Data Collection/Extraction Methods Data were publicly available, and we extracted them from the Centers for Disease Control and Prevention website. Principal Findings Altogether, at 60.4% of visits at which a new psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 59.1% in 2006‐2007 to 67.7% in 2008‐2009 and then decreased to 52.0% in 2014‐2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits ( OR = 0.02; 95% CI , 0.01‐0.04). Visits to non‐psychiatric specialists showed 6.90 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI , 5.38‐8.86). Conclusion New psychotropic medications are commonly initiated without any psychiatric diagnosis, especially by non‐psychiatrist physicians. Non‐psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.