UCI-RCOC NEURODEVELOPMENTAL PROGRAM AND CLINIC A 14 Year Review February 2, 2012.
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Transcript of UCI-RCOC NEURODEVELOPMENTAL PROGRAM AND CLINIC A 14 Year Review February 2, 2012.
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UCI-RCOC
NEURODEVELOPMENTAL PROGRAM AND CLINIC
A 14 Year ReviewFebruary 2, 2012
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UCI Professional PersonnelUCI Professional Personnel
Ira T. Lott, MD - Pediatric Neurologist and Director
Paul Touchette, EdD – Psychologist
Gail Fernandez, MD – Psychiatrist
Anne Tournay, MD – Neurologist
Larry Plon, Pharm D. - Research Pharmacist
Christy Hom, PhD - Neuropsychologist and Coordinator
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ObjectivesObjectives
1) To determine the extent of polypharmacy for psychoactive drugs in the RCOC consumer
population
2) Interdisciplinary Team Clinic for RCOC consumers with medication
and behavioral issues
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Psychoactive Drug Psychoactive Drug SurveySurvey
30 months consecutive data
CalOptima Pharmacy Billing Records Accessed
Cross-linked to RCOC consumers
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30 month Medication 30 month Medication SurveySurvey
7,419 psychoactive drug prescriptions for RCOC population ( 26.8% of all
prescriptions written)
62% had more than one psychoactive drug prescription and 32% had 3 or
more
First study of its kind in the DD population, published J Intellect
Disability Research
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30 Month Survey of 30 Month Survey of Psychoactive MedicationsPsychoactive Medications
2,229,970 prescriptions surveyed
92,162 patients
25% were for psychoactive drugs
Is it possible to determine medication adherence from the
pharmacy billing records?
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Calculation of Medication Calculation of Medication AdherenceAdherence
Ratio = # of days of drug supply # of days from first to
last refill
Adherence “yes” if ratio is ≥0.75 to 1.1
Adherence “no” if ratio<0.75
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Adherence by Residence Adherence by Residence TypeType
Cross linked adherence calculations with residence type
from CDER
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Number of Clients by Number of Clients by ResidenceResidence
ResidenceFrequenc
yValid
PercentCumulative Percent
Own Home/ Parent/Guardian
749 32.5 32.6
Own Home/ Independent Living
140 6.1 38.7
Supported Living 113 4.9 43.6
CCF (RCFE) 11 .5 44.5
CCF (1-3) 4 .2 44.7
CCF (4-6) 725 31.5 76.2
CCF (7-15) 40 1.7 77.9
CCF (16-49) 79 3.4 81.3
CCF (50+) 4 .2 81.5Total = 1865 RCOC Consumers
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Psychoactive vs. Other Drug Psychoactive vs. Other Drug TypesTypes
Drug Type Frequency
Percent of all fills
Psychoactive 546046 24.5
Cardiac 135691 6.1
Antihypertensive 67872 3.0
Antilipemic 61718 2.8
Antidiabetic 35119 1.6
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Clients in Own Home Clients in Own Home Significantly Less Adherent for Significantly Less Adherent for
All 5 Medication ClassesAll 5 Medication ClassesOwn Home vs. CCF
Chi-SquareOdds Ratio
(95% conf. interval)Value
p-value
Antidiabetic 4.04 0.04 6.58 (0.80-53.37)
Antilipemic 18.31 <0.00 7.29 (2.64-20.27)
Cardiac 5.51 0.02 2.98 (1.16- 7.62)
Blood pressure
18.69 <0.00 14.38 (3.19-65.31)
Psychoactive Medications
116.5 <0.00 2.07 (1.81- 2.38)
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Factors Affecting Factors Affecting Medication AdherenceMedication Adherence
Residence Group home residents are twice as likely to
adhere to their psychoactive prescriptions than consumers who live in their own
home or family home
Medication form Divalproex ER is 2.01 times more likely to be
adhered to than regular Divalproex
Polypharmacy, gender, and age did not affect adherence.
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Conclusions from Adherence Conclusions from Adherence StudyStudy
Medication adherence is problematic for clients living in their own home
This is very similar to the general population
Public health efforts towards medication adherence indicated
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INTERDISCIPLINARY INTERDISCIPLINARY CLINICCLINIC
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Introduction to Introduction to Interdisciplinary ClinicInterdisciplinary Clinic
Team consists of neurologist, psychiatrist, educational, research
and neuropsychologists
All clients referred by RCOC (1837 consumers evaluated since 1998)
Interdisciplinary team review of diagnostic, medication, and
treatment options for each client
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Primary Referral ReasonsPrimary Referral Reasons
Polypharmacy
Medication side effects
Increasing behavioral problems
Need for diagnostic services
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Mean Age of 1500 Mean Age of 1500 ConsumersConsumers
Mean ages of consumers in years 2007-2011 less than in years 2001-2006; p<.001
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Age Distribution of Clinic Age Distribution of Clinic PopulationPopulation
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Gender DistributionGender Distribution
Distribution from 2001-2004 significantly different than that from 2007-
2011
Distribution in 2005 significantly different than that in 2006, but not from
that in 2004
Distribution from 2010-2011 significantly different from 2007
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Level of Intellectual DisabilityLevel of Intellectual Disability
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DistributionDistribution of Intellectual of Intellectual DisabilityDisability
*Prior to 2008, consumers with No Intellectual Disability had their ID Level coded as missing
% of Consumers with ID, Severity Unspecified has sharply increased since 2008
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Number of Psychoactive Number of Psychoactive Medications Medications Pre-Pre-ClinicClinic
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Average # of Psychoactive Average # of Psychoactive Medications Pre-ClinicMedications Pre-Clinic
Average # of medications from 2001-2007 greater than average # of medications from 2008-2011; p<.001
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Top 25 Medications Pre-Top 25 Medications Pre-ClinicClinic
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Major Psychiatric Diagnostic Major Psychiatric Diagnostic CategoriesCategories
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Diagnostic Trends by YearDiagnostic Trends by Year
Significant increase in consumers with an Anxiety Disorder or Autistic Disorder
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Diagnostic Trends by YearDiagnostic Trends by Year
Significant decrease in consumers with Bipolar Disorder, OCD, or Impulse Control Disorder
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DIFFERENCES DIFFERENCES BETWEEN BETWEEN DISORDERSDISORDERS
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Associations with # of Associations with # of Psychoactive MedicationsPsychoactive Medications
Schizophrenia, Bipolar Disorder, and Impulse Control Disorder associated
with more medications
Autistic Disorder associated with fewer medications (possibly because
younger in age)
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Associations with Associations with SchizophreniaSchizophrenia
Significantly older than patients not diagnosed with Schizophrenia
Significantly higher intellectual functioning
Taking significantly more psychoactive medications than those without
Schizophrenia
Significantly better personal, community, and social skills than rest of clinic
population
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Associations with Bipolar Associations with Bipolar DisorderDisorder
Taking significantly more psychoactive medications than those without Bipolar
Disorder
Caregivers less compliant in following clinic recommendations
Significantly more irritable than consumers without Bipolar Disorder
Significantly better personal, community, and social skills than rest of clinic population
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Associations with Autistic Associations with Autistic DisorderDisorder
Significantly younger than consumers without Autism
Taking fewer psychoactive medications
Significantly less personal, community, and social skills
Significantly more maladaptive behaviors (both internalizing and
externalizing behaviors)