Anke Rentsch

[Psychopharmaceutical prescriptions to older people. A comparison between patients in aged- and nursing homes, outpatient treatment with nursing care and outpatients without nursing care].

Zusammenfassung.Inwieweit Pflegestufe, Geschlecht, Alter und ambulante bzw. Versorgung im Heim Einfluss auf die Psychopharmaka-Verordnungen bei älteren Menschen haben, untersucht die vorliegende Studie. Hierzu wurden Heimpatienten mit ambulant versorgten Patienten (mit und ohne Pflegestufe) verglichen. Es wurden die Daten von 3592 Versicherten der BKK Berlin 1999 hinsichtlich Versicherten-, Rezept-, Arzt- und ggf. Krankenhauscharakteristika in einer Längsschnittstudie retrospektiv ausgewertet. Insgesamt wurden den Heimbewohnern signifikant mehr Psychopharmaka verordnet, insbesondere mehr Neuroleptika (1-Jahres-Prävalenz 40% versus 12,4% und 7,4%). Hingegen erscheint die Qualität der Verordnungen (Verwendung wechselwirkungs- und nebenwirkungsärmerer Stoffgruppen) im Heimbereich höher zu sein. Ambulant verordneten meist Allgemeinmediziner (ca. 45%) und Internisten, im Heimbereich Nervenärzte (ca. 37%). Frauen wurden anteilig häufiger als Männern psychotrop wirksame Substanzen verschrieben. Mit steigender Pflegestufe nahm der Anteil der mit sedierenden Psychopharmaka medizierten Patienten zu. Ambulant wären Verbesserungen vor allem in der Qualität der Verordnungen der psychotropen Medikation wünschenswert, im Heimbereich vor allem in einer Reduzierung der Menge.Summary.To determine, whether age, sex, grade of need of care and living in nursing homes can influence prescribing behavior in elderly. In a retrospective and longitudinal study, the pattern of psychoactive drug prescriptions of nursing home residents was compared with non-institutionalized people with and without need of care. During 1999, the computerized files of 3592 people (> 60 years), insured by a health insurance fund (BKK) in Berlin, Germany, were obtained. Nursing home residents received significantly more prescriptions of psychoactive drugs than the others, especially more neuroleptics (40.1% versus 12.4% and 7.4%). Quality of prescriptions seemed to be higher in nursing homes (use of drugs with fewer side effects and less possible interactions), psychoactive drug prescriptions were given more frequently by psychiatrists and neurologists (37%). Non-institutionalized patients received them most from general practitioners (45%). Women received more prescriptions of psychoactive drugs than male patients. With rising grade of need of care, proportionately more patients received psychoactive drugs. The results of this study show some evidence of the lacking quality in the prescriptions of psychopharmaceuticals to the elderly.

Patients’ perspectives on palliative chemotherapy of colorectal and non - colorectal cancer: a prospective study in a chemotherapy- experienced population

BackgroundA better understanding of patients’ views on the benefit and burden obtained from palliative chemotherapy would facilitate shared decision making. We evaluated palliative cancer patients’ reported outcomes (PROs) for toxicity and investigated the survival threshold for which they would repeat chemotherapy (CTx).MethodsPatients who had received a minimum of three months of palliative CTx for advanced colorectal (CRC) or non-colorectal (non-CRC: upper gastrointestinal, lung and head-and-neck) cancer were assessed by questionnaire. Patients were questioned about PROs for toxicity, subjective burden from side effects, and were asked for the survival threshold necessary for them to repeat CTx. Expected survival (sum of indicated survival threshold and median survival time with best supportive care) was compared to the patients’ actual survival.ResultsOne hundred and thirty-four patients (CRC: 58; non-CRC: 76) were surveyed. The most frequent PRO- grade 3/4 toxicities were acne (12.8%), fatigue (9.0%), and diarrhea (8.5%). The symptom causing the highest subjective burden was fatigue and was worse than expected in 29.9% of the patients. The median survival threshold for which patients would repeat CTx was significantly longer in CRC than in non-CRC patients (p=0.01). Median expected survival was significantly longer than actual median survival (CRC: 44.0 months [22.0-65.9] compared with 30.0 months of actual survival [20.9-39.1]; non-CRC: 22.0 months [15.3-28.6] compared with 19.0 months of actual survival [15.1-22.9], p=0.03).ConclusionFatigue deserves more attention when toxicity of treatment and symptoms of disease are explained to patients. Patients’ survival expectations from palliative chemotherapy are higher than previously described, exceed the median survival time known from phase III trials, and are significantly longer than their actual survival.

Drug Use Patterns in Young German Women and Association with Mental Disorders

BACKGROUND: There is a lack of data about drug use patterns in young women. Mental disorders may influence those drug use patterns. OBJECTIVE: To evaluate drug use patterns (prescribed drugs, self-medication) in general and in relation to the prevalence rates of mental disorders in young German women. METHODS: A total of 2064 women (18–24 y old), obtained in a random clustered sample, were asked about their actual and former medication use. Moreover, a structured psychological interview (Diagnostic Interview for Mental Disorders) was conducted with each woman to evaluate the prevalence of mental disorders (according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition). RESULTS: Oral contraceptives (55.9%), thyroid preparations (7.1%), respiratory system drugs (9.4%), and nervous system drugs (8%) were the most commonly used medications. Only 10% of the women with one or more mental disorders used psychotropic medication. As expected, women with mental disorders were significantly more likely to use antidepressants and psycholeptic agents (ie, sedatives/hypnotics, antipsychotics) than were women without any mental disorder. However, there were no significant differences in use of pain medication. CONCLUSIONS: The results of this study indicate an apparently inadequate supply of drugs acting on the nervous system for women with mental disorders in Germany. Further studies on different age and gender groups are needed. It is important to evaluate the prevalence of diseases and drug use at the same time so as to identify deficits in drug therapy and optimize prescription and self-medication use.

Psychopharmakaverordnungen an älteren Menschen

Zusammenfassung.Inwieweit Pflegestufe, Geschlecht, Alter und ambulante bzw. Versorgung im Heim Einfluss auf die Psychopharmaka-Verordnungen bei älteren Menschen haben, untersucht die vorliegende Studie. Hierzu wurden Heimpatienten mit ambulant versorgten Patienten (mit und ohne Pflegestufe) verglichen. Es wurden die Daten von 3592 Versicherten der BKK Berlin 1999 hinsichtlich Versicherten-, Rezept-, Arzt- und ggf. Krankenhauscharakteristika in einer Längsschnittstudie retrospektiv ausgewertet. Insgesamt wurden den Heimbewohnern signifikant mehr Psychopharmaka verordnet, insbesondere mehr Neuroleptika (1-Jahres-Prävalenz 40% versus 12,4% und 7,4%). Hingegen erscheint die Qualität der Verordnungen (Verwendung wechselwirkungs- und nebenwirkungsärmerer Stoffgruppen) im Heimbereich höher zu sein. Ambulant verordneten meist Allgemeinmediziner (ca. 45%) und Internisten, im Heimbereich Nervenärzte (ca. 37%). Frauen wurden anteilig häufiger als Männern psychotrop wirksame Substanzen verschrieben. Mit steigender Pflegestufe nahm der Anteil der mit sedierenden Psychopharmaka medizierten Patienten zu. Ambulant wären Verbesserungen vor allem in der Qualität der Verordnungen der psychotropen Medikation wünschenswert, im Heimbereich vor allem in einer Reduzierung der Menge.Summary.To determine, whether age, sex, grade of need of care and living in nursing homes can influence prescribing behavior in elderly. In a retrospective and longitudinal study, the pattern of psychoactive drug prescriptions of nursing home residents was compared with non-institutionalized people with and without need of care. During 1999, the computerized files of 3592 people (> 60 years), insured by a health insurance fund (BKK) in Berlin, Germany, were obtained. Nursing home residents received significantly more prescriptions of psychoactive drugs than the others, especially more neuroleptics (40.1% versus 12.4% and 7.4%). Quality of prescriptions seemed to be higher in nursing homes (use of drugs with fewer side effects and less possible interactions), psychoactive drug prescriptions were given more frequently by psychiatrists and neurologists (37%). Non-institutionalized patients received them most from general practitioners (45%). Women received more prescriptions of psychoactive drugs than male patients. With rising grade of need of care, proportionately more patients received psychoactive drugs. The results of this study show some evidence of the lacking quality in the prescriptions of psychopharmaceuticals to the elderly.

Recognition and therapy of eating disorders in young women in primary care

ObjectiveTo evaluate the prevalence of eating disorders (ED) in a general population sample of young German women, compare those to primary care diagnoses, and investigate their medical treatments.MethodsIn a prospective epidemiological study, a representative sample of young women (n=1555, between 18 and 25 years of age) was questioned twice during a structured psychological interview (F-DIPS) for mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). At the same time, personal health insurance data were recorded and primary care physicians’ diagnoses and payments for services rendered were analyzed.ResultsThe lifetime prevalence of eating disorders was 3.3% (2.3% anorexia nervosa, 1.1% bulimia nervosa). The primary care physicians diagnosed eating disorders in only about 20% of the women concerned. Eating disorders were often overlooked, although physicians detected physical and mental complaints (e.g., menstrual cycle disorders, abnormal weight loss, flatulence, depression, anxiety disorders), which are closely related to eating disorders. If the primary care physicians had diagnosed eating disorders, they mostly recommended psychotherapeutic treatment as the only measure, or in combination with pharmacological therapy.ConclusionThe study indicates that primary care physicians need better training, particularly in diagnostic procedures for eating disorders. Screening methods and systematic assessment might be helpful in improving the detection of eating disorders in primary care

Psychopharmakaverordnungen an lteren MenschenEin Vergleich zwischen Patienten aus Alten- und Pflegeheimen, ambulant behandelten Pflegefllen und ambulanten Patienten ohne Pflegebedarf

Zusammenfassung.Inwieweit Pflegestufe, Geschlecht, Alter und ambulante bzw. Versorgung im Heim Einfluss auf die Psychopharmaka-Verordnungen bei älteren Menschen haben, untersucht die vorliegende Studie. Hierzu wurden Heimpatienten mit ambulant versorgten Patienten (mit und ohne Pflegestufe) verglichen. Es wurden die Daten von 3592 Versicherten der BKK Berlin 1999 hinsichtlich Versicherten-, Rezept-, Arzt- und ggf. Krankenhauscharakteristika in einer Längsschnittstudie retrospektiv ausgewertet. Insgesamt wurden den Heimbewohnern signifikant mehr Psychopharmaka verordnet, insbesondere mehr Neuroleptika (1-Jahres-Prävalenz 40% versus 12,4% und 7,4%). Hingegen erscheint die Qualität der Verordnungen (Verwendung wechselwirkungs- und nebenwirkungsärmerer Stoffgruppen) im Heimbereich höher zu sein. Ambulant verordneten meist Allgemeinmediziner (ca. 45%) und Internisten, im Heimbereich Nervenärzte (ca. 37%). Frauen wurden anteilig häufiger als Männern psychotrop wirksame Substanzen verschrieben. Mit steigender Pflegestufe nahm der Anteil der mit sedierenden Psychopharmaka medizierten Patienten zu. Ambulant wären Verbesserungen vor allem in der Qualität der Verordnungen der psychotropen Medikation wünschenswert, im Heimbereich vor allem in einer Reduzierung der Menge.Summary.To determine, whether age, sex, grade of need of care and living in nursing homes can influence prescribing behavior in elderly. In a retrospective and longitudinal study, the pattern of psychoactive drug prescriptions of nursing home residents was compared with non-institutionalized people with and without need of care. During 1999, the computerized files of 3592 people (> 60 years), insured by a health insurance fund (BKK) in Berlin, Germany, were obtained. Nursing home residents received significantly more prescriptions of psychoactive drugs than the others, especially more neuroleptics (40.1% versus 12.4% and 7.4%). Quality of prescriptions seemed to be higher in nursing homes (use of drugs with fewer side effects and less possible interactions), psychoactive drug prescriptions were given more frequently by psychiatrists and neurologists (37%). Non-institutionalized patients received them most from general practitioners (45%). Women received more prescriptions of psychoactive drugs than male patients. With rising grade of need of care, proportionately more patients received psychoactive drugs. The results of this study show some evidence of the lacking quality in the prescriptions of psychopharmaceuticals to the elderly.

The prescribing of lipid lowering drugs during a 1‐year period: analysis of 7490 health insurance files

A study of prescription patterns by office‐based physicians was conducted to analyse the use of lipid lowering drugs (LLD) in a Germany area of 1,768,874 inhabitants during a 1‐year period. The prescription database consisted of health insurance files from a random sampling of persons (n=7490) belonging to a large statutory health insurance organization during 1993–1994. During the study period LLD were prescribed to about 2.8% of the study population. Fibrates (43.7%) were the most frequently prescribed drugs followed by HMG‐CoA reductase inhibitors (29.5%) and nicotinic acid with derivatives (21.7%). The prevalence of treatment rose with increasing age peaking among 60‐ to 69‐year‐olds (7.5%). More than two‐thirds of the patients were not treated continuously, receiving LLD for less than 6 months. Thus, in patients being treated with LLD, the therapy seems to be ineffective due to the short episodes of drug administration. The presence of hyperlipidaemia plus additional risk factors such as hypertension led to a higher rate of LLD prescriptions than that for hyperlipidaemia alone. Only half of the patients with a history of previous myocardial infarction and hyperlipidaemia received LLD. Furthermore, patients with hyperlipidaemia and additional risk factors such as arterial hypertension, diabetes mellitus and coronary heart disease (CHD), in whom administration of LLD has often been shown to be effective, were by far too infrequently treated with these drugs. Copyright

Validation of prognostic risk scores for patients undergoing resection for pancreatic cancer

BACKGROUND/OBJECTIVES A better stratification of patients into risk groups might help to select patients who might benefit from more aggressive therapy. The aim of this study was to validate five prognostic scores in patients resected for pancreatic ductal adenocarcinoma (PDAC). METHODS Included were 307 PDAC patients who underwent resection with curative intent. Five clinical risk scores were selected and applied to our study population. Survival analyses were carried out using univariate and multivariate proportional hazards regression. RESULTS Prognostic stratification was strong for the Heidelberg score (p < 0.001) and the Memorial Sloan Kettering Cancer Center (MSKCC) nomogram (p = 0.001) and moderate for the Botsis score (p = 0.033). There was no significant prognostic value for the Early Mortality Risk Score (p = 0.126) and McGill Brisbane Symptom Score (p = 0.133). Positive resection margin (HR 1.53, 95% CI 1.08-2.16) and pain [pain (HR 1.40, CI 1.03-1.91), back pain (HR 1.67, 95% CI 1.08-2.57)] were independent prognostic factors on multivariate analysis. CONCLUSIONS The Heidelberg score and MSKCC nomogram provided adequate risk stratification in our independent study cohort. Further studies in independent patient cohorts are required to achieve higher levels of validation.

Ongoing Clinical Trials

CAPP 2 Randomized controlled trial of colorectal polyp and cancer prevention using aspirin and resistant starch in carriers of hereditary nonpoly-posis colon cancer (HNPCC) Prof. John Burn University of Newcastle, UK Phase II, multicenter (33 centers), prospective, double-blind trial Factorial design Regimen: Aspirin 600 mg, resistant starch 30 g for 2-4 years Control: Placebo/active Endpoint: Colorectal neoplasm Patient population: Gene carriers of hereditary HNPCC n=1000 Ongoing (start January 1999; end December 2006) MRC, Cancer Research UK, Bayer AG, National Starch and Chemical Company Ms. Gail Barker Newcastle upon Tyne, UK

Psychopharmakaverordnungen an lteren Menschen@@@Prescriptions of psychoactive drugs to elderly. A comparison between nursing home residents with need of care and patients living at home with and without need of care: Ein Vergleich zwischen Patienten aus Alten- und Pflegeheimen, ambulant behandelten Pflegefllen und ambulanten Patienten ohne Pflegebedarf

Zusammenfassung.Inwieweit Pflegestufe, Geschlecht, Alter und ambulante bzw. Versorgung im Heim Einfluss auf die Psychopharmaka-Verordnungen bei älteren Menschen haben, untersucht die vorliegende Studie. Hierzu wurden Heimpatienten mit ambulant versorgten Patienten (mit und ohne Pflegestufe) verglichen. Es wurden die Daten von 3592 Versicherten der BKK Berlin 1999 hinsichtlich Versicherten-, Rezept-, Arzt- und ggf. Krankenhauscharakteristika in einer Längsschnittstudie retrospektiv ausgewertet. Insgesamt wurden den Heimbewohnern signifikant mehr Psychopharmaka verordnet, insbesondere mehr Neuroleptika (1-Jahres-Prävalenz 40% versus 12,4% und 7,4%). Hingegen erscheint die Qualität der Verordnungen (Verwendung wechselwirkungs- und nebenwirkungsärmerer Stoffgruppen) im Heimbereich höher zu sein. Ambulant verordneten meist Allgemeinmediziner (ca. 45%) und Internisten, im Heimbereich Nervenärzte (ca. 37%). Frauen wurden anteilig häufiger als Männern psychotrop wirksame Substanzen verschrieben. Mit steigender Pflegestufe nahm der Anteil der mit sedierenden Psychopharmaka medizierten Patienten zu. Ambulant wären Verbesserungen vor allem in der Qualität der Verordnungen der psychotropen Medikation wünschenswert, im Heimbereich vor allem in einer Reduzierung der Menge.Summary.To determine, whether age, sex, grade of need of care and living in nursing homes can influence prescribing behavior in elderly. In a retrospective and longitudinal study, the pattern of psychoactive drug prescriptions of nursing home residents was compared with non-institutionalized people with and without need of care. During 1999, the computerized files of 3592 people (> 60 years), insured by a health insurance fund (BKK) in Berlin, Germany, were obtained. Nursing home residents received significantly more prescriptions of psychoactive drugs than the others, especially more neuroleptics (40.1% versus 12.4% and 7.4%). Quality of prescriptions seemed to be higher in nursing homes (use of drugs with fewer side effects and less possible interactions), psychoactive drug prescriptions were given more frequently by psychiatrists and neurologists (37%). Non-institutionalized patients received them most from general practitioners (45%). Women received more prescriptions of psychoactive drugs than male patients. With rising grade of need of care, proportionately more patients received psychoactive drugs. The results of this study show some evidence of the lacking quality in the prescriptions of psychopharmaceuticals to the elderly.