Using electronic health records to characterize prescription patterns: focus on antidepressants in nonpsychiatric outpatient settings.
| Title: | Using electronic health records to characterize prescription patterns: focus on antidepressants in nonpsychiatric outpatient settings. |
|---|---|
| Authors: | Deferio JJ; Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA.; Levin TT; Beacon Health Options, New York, New York, USA.; Cukor J; Department of Psychiatry, Collaborative and Integrative Care, Weill Cornell Medicine, Cornell University, New York, New York, USA.; Banerjee S; Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA.; Abdulrahman R; Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA.; Sheth A; Kno.e.sis Center, Wright State University, Dayton, Ohio, USA.; Mehta N; Department of Anesthesiology, Pain Medicine/Management, Weill Cornell Medicine, Cornell University, New York, New York, USA.; Pathak J; Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA. |
| Source: | JAMIA open [JAMIA Open] 2018 Oct; Vol. 1 (2), pp. 233-245. Date of Electronic Publication: 2018 Sep 24. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Oxford University Press on behalf of the American Medical Informatics Association Country of Publication: United States NLM ID: 101730643 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2574-2531 (Electronic) Linking ISSN: 25742531 NLM ISO Abbreviation: JAMIA Open Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Cary, NC] : Oxford University Press on behalf of the American Medical Informatics Association, [2018]- |
| Abstract: | Objective: To characterize nonpsychiatric prescription patterns of antidepressants according to drug labels and evidence assessments (on-label, evidence-based, and off-label) using structured outpatient electronic health record (EHR) data.; Methods: A retrospective analysis was conducted using deidentified EHR data from an outpatient practice at a New York City-based academic medical center. Structured "medication-diagnosis" pairs for antidepressants from 35 325 patients between January 2010 and December 2015 were compared to the latest drug product labels and evidence assessments.; Results: Of 140 929 antidepressant prescriptions prescribed by primary care providers (PCPs) and nonpsychiatry specialists, 69% were characterized as "on-label/evidence-based uses." Depression diagnoses were associated with 67 233 (48%) prescriptions in this study, while pain diagnoses were slightly less common (35%). Manual chart review of "off-label use" prescriptions revealed that on-label/evidence-based diagnoses of depression (39%), anxiety (25%), insomnia (13%), mood disorders (7%), and neuropathic pain (5%) were frequently cited as prescription indication despite lacking ICD-9/10 documentation.; Conclusions: The results indicate that antidepressants may be prescribed for off-label uses, by PCPs and nonpsychiatry specialists, less frequently than believed. This study also points to the fact that there are a number of off-label uses that are efficacious and widely accepted by expert clinical opinion but have not been included in drug compendia. Despite the fact that diagnosis codes in the outpatient setting are notoriously inaccurate, our approach demonstrates that the correct codes are often documented in a patient's recent diagnosis history. Examining both structured and unstructured data will help to further validate findings. Routinely collected clinical data in EHRs can serve as an important resource for future studies in investigating prescribing behaviors in outpatient clinics. |
| References: | Psychiatr Serv. 2009 Aug;60(8):1015-23. (PMID: 19648187); Arch Fam Med. 1994 Apr;3(4):333-7. (PMID: 8012621); BMJ. 2017 Feb 21;356:j603. (PMID: 28228380); Asian J Psychiatr. 2017 Dec;30:159-162. (PMID: 29055250); J Clin Psychiatry. 2014 Feb;75(2):169-77. (PMID: 24345349); Yale J Biol Med. 2013 Jun 13;86(2):139-46. (PMID: 23766735); Psychiatr Serv. 2003 May;54(5):682-7. (PMID: 12719498); Am J Psychiatry. 1994 Jul;151(7):1069-72. (PMID: 8010365); Int J Risk Saf Med. 2011;23(2):125-32. (PMID: 21673422); Sleep Med. 2004 Jan;5(1):15-20. (PMID: 14725822); J Neurol Neurosurg Psychiatry. 2010 Dec;81(12):1372-3. (PMID: 20543189); Curr Med Res Opin. 2010 Jun;26(6):1343-53. (PMID: 20373875); Arch Intern Med. 2006 May 8;166(9):1021-6. (PMID: 16682577); Arch Womens Ment Health. 2016 Jun;19(3):501-5. (PMID: 26669601); J Am Board Fam Med. 2012 May-Jun;25(3):283-90. (PMID: 22570391); Age Ageing. 2012 Sep;41(5):646-52. (PMID: 22743149); Reumatol Clin. 2005 Aug;1(2):116-20. (PMID: 21794246); Pain. 2007 Dec 5;132(3):237-251. (PMID: 17920770); Psychol Med. 2012 Jan;42(1):41-50. (PMID: 21682950); Cochrane Database Syst Rev. 2014 Jan 03;(1):CD007115. (PMID: 24385423); Farm Hosp. 2012 Jul-Aug;36(4):180-6. (PMID: 22030161); Am J Psychiatry. 2006 May;163(5):893-8. (PMID: 16648332); Arch Gen Psychiatry. 2009 Aug;66(8):848-56. (PMID: 19652124); Cochrane Database Syst Rev. 2007 Oct 17;(4):CD005454. (PMID: 17943857); J Affect Disord. 2013 Dec;151(3):1025-32. (PMID: 24119920); Br J Clin Pharmacol. 2006 Nov;62(5):582-90. (PMID: 16822281); Pharmacoepidemiol Drug Saf. 2009 Nov;18(11):1094-100. (PMID: 19697444); J Clin Psychiatry. 2006 Jun;67(6):972-82. (PMID: 16848658); Ann Intern Med. 2017 Apr 04;166(7):480-492. (PMID: 28192790); Ann Intern Med. 2017 Apr 4;166(7):514-530. (PMID: 28192789); Pain. 1991 Apr;45(1):3-9. (PMID: 1861872); Arch Intern Med. 2012 May 28;172(10):781-8. (PMID: 22507695); Pain Pract. 2003 Jun;3(2):135-43. (PMID: 17163912); JAMA. 2016 May 24-31;315(20):2230-2. (PMID: 27218634); AMIA Annu Symp Proc. 2018 Apr 16;2017:1581-1588. (PMID: 29854228); Am J Psychiatry. 2006 Jul;163(7):1187-98. (PMID: 16816223); Pain. 2004 Aug;110(3):697-706. (PMID: 15288411); J Gen Intern Med. 2017 Apr;32(4):404-410. (PMID: 28243873); Drug Saf. 2010 Jul 1;33(7):559-67. (PMID: 20553057); Lancet Neurol. 2015 Feb;14(2):162-73. (PMID: 25575710); J Affect Disord. 2011 Apr;130(1-2):26-36. (PMID: 20708274); Pharmacotherapy. 2008 Dec;28(12):1443-52. (PMID: 19025425) |
| Grant Information: | P50 MH113838 United States MH NIMH NIH HHS; R01 MH105384 United States MH NIMH NIH HHS; UL1 TR002384 United States TR NCATS NIH HHS; R01 GM105688 United States GM NIGMS NIH HHS; UL1 TR000457 United States TR NCATS NIH HHS |
| Contributed Indexing: | Keywords: EHR; antidepressants; outpatient; prescription patterns |
| Entry Date(s): | Date Created: 20181127 Latest Revision: 20240724 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC6241504 |
| DOI: | 10.1093/jamiaopen/ooy037 |
| PMID: | 30474077 |
| Database: | MEDLINE |
Journal Article