Quebec’s eldercare drug culture: a provincial picture paints 1,314 shocking prescriptions

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Old people asleep nursing home

 

The huge variance in the rates and ways antipsychotic are prescribed to elderly people with dementia around the world and the strong push to discourage and decrease their use are proof there are better ways to help people with dementia live well until they die.

I’ve blogged about the United Kingdom’s success in quickly reducing the use of antipsychotics; here’s an excerpt:

In June 2012 the UK’s National Dementia and Antipyschotic Prescribing Audit Summary Report showed that while the number of newly diagnosed people with dementia increased by almost 68 per cent between 2006 and 2011, there was a 60 per cent decrease in the number of people with dementia receiving prescriptions of antipsychotic medication (i.e. to 7 per cent in 2011 from about 17 per cent in 2006) .

In contrast, the rate of prescription of antipsychotics to the elderly has remained virtually the same (i.e. between 300 and 600 prescriptions per 1,000 elderly people) in nine of Canada’s 10 provinces over a similar period (2009 – 2014) .

Nine Canadia provinces

 

Shockingly, in Quebec, the province in which I live, the rate of prescribing antipsychotics to the elderly was 1,314 prescriptions per 1,000 in 2014. That’s 1.3 prescriptions per elder — four times the prescribing rate in Alberta and Newfoundland, double the rate in Ontario and New Brunswick. Antipsychotics are designed to help people with schizophrenia, which occurs at a rate of about one to two per cent in populations overall. What’s wrong with this picture?

Quebec rate antipsychotics

 

AND, while the UK reduced the number of antipsychotic prescriptions to the elderly by 52 per cent from 2008 to 2011, the rate of prescribing antipsychotics to the elderly INCREASED by 20 per cent in Quebec from 2009 to 2011. Overall, it rose by 31 per cent between 2009 and 2014. Hmmmmm.

Furthermore according to the 2015 Ontario Drug Policy Network report:

  • Prescriptions for antipsychotics to elderly patients in Canada increased nearly 32 per cent between 2009 and 2014, to about 4 million prescription from about 3 million . (Download the 2015 Ontario Drug Policy Network report here.)
  • The total amount spent on antipsychotic prescriptions dispensed to elderly patients in Canada increased by 21 per cent to $75 million between 2009 and 2014. As the rates in the other nine provinces remained relatively flat, Quebec is likely responsible for the lion’s share of the cost increase.
  • The bulk (97 per cent) of antipsychotics prescribed in Canada are atypical antipsychotics such as quetiapine and risperdone.

Are there twice as many crazy old people per thousand in Quebec than there are in Ontario? Are Quebec seniors with dementia four times more likely to require medication than those in Alberta? And if so why? Why do rates of prescription vary so dramatically between provinces, regions and countries? Why do some places resist change and continue to prescribe drugs “off label” to old people with dementia knowing full well the risks include an earlier death? Why are some places, provinces, regions and countries committed to change and others seem to be in denial about moving forward?

Lots of questions. I continue to explore answers.

Stay tuned.

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9 Comments

  1. Here, in NZ, doctors do not prescribe drugs unless required I am pleased to say. Neither my Mum or husband were given drugs for Alzheimer’s – they talked to me about them but in both cases did not feel that they would help and I agreed. Both were initially on Heart pills for hypertension and during their journey both were discontinued after discussion with me. Personally I worried about anxiety but by using strategies to keep them calm managed not to need medication. I have seen people on medication for anxiety who basically have lost quality of life through this.

    Personally my feeling is that we should only take medication when it is necessary.

  2. This is an issue that has been on my radar for years – as a medical writer, I’m able to leap clinical studies with a single bound, and doctors are startled when I start spouting statistics.

    My mother’s GP refused to take her off her anticholesterol drug, despite the fact that her cholesterol levels are fine and despite recent concerns about statins increasing the risk of dementia. He never once suggested diet or exercise to address the original problem of high cholesterol.

    His exact words were, “If I stop the prescription and she strokes out, it’s on you, do you want that?”

    This indicates to me that his fear of malpractice is stronger than his knowledge of pharmaceuticals and/or his concern for my mother… but again, I’m not surprised.

    I’ve dealt with hundreds of physicians and specialists over the years. Especially here in Quebec, physicians don’t have the time and/or motivation to keep up with current research.

    Off-label prescribing is a HUGE problem, fuelled by pharma reps and conference chats. Awareness of the “behind the scenes” dynamics is crucial; however, this is all anecdotal.

    Keep on sharing, and by the way, what a great visual! It is literally painted with despair.

    • “I’m able to leap clinical studies with a single bound.”

      Good for you! This is the thing with experts: they think they can “out expert” you and baffle you with their big words, multiple letters after their names and years and years of this that and the other.

      I have come to trust my own observations and good common sense over the so-called expertise of experts. I declare myself an “expert by experience,” and I continue to learn by having an open mind about innovation, by thinking out of the box, by listening to and collaborating with people who know what they’re talking about while rejecting the opinions of those who clearly don’t.

      It seems that great swaths of humanity prefer to do things the way they’ve always been done, even when those things have been proven ineffective and/or are no longer appropriate for the new reality whatever that might be at the time.

      I’m all for adopting what works and deleting what doesn’t. It’s amazing to me that that makes me an anomaly…

      Thanks for connecting and commenting – lone voices need to sing in tune.

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