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Prescribing trends in veterans with posttraumatic stress disorder.
J Clin Psychiatry. 2012 Mar; 73(3):297-303.JC

Abstract

OBJECTIVE

The revised Department of Veterans Affairs (VA) and Department of Defense Clinical Practice Guideline for Management of Post-Traumatic Stress recommends against long-term use of benzodiazepines to manage posttraumatic stress disorder (PTSD). An analysis of recent trends among veterans receiving care for PTSD in the VA noted a decreasing proportion receiving benzodiazepines. The authors examined prescribing patterns for other medications to better understand the general context in which the changes in benzodiazepine prescribing have occurred in the VA.

METHOD

Administrative VA data from fiscal years 1999 through 2009 were used to identify veterans with PTSD using ICD-9 codes extracted from inpatient discharges and outpatient encounters. Prescribing of antidepressants, antipsychotics, and hypnotics was determined for each fiscal year using prescription drug files.

RESULTS

The proportion of veterans receiving either of the 2 Clinical Practice Guideline-recommended first-line pharmacotherapy treatments for PTSD, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, increased from 49.7% in 1999 to 58.9% in 2009. In addition to reduced benzodiazepine prescriptions, the overall frequency of antipsychotic use declined 6.1%, from 20.0% in 1999 to 13.9% in 2009. Nonbenzodiazepine hypnotic prescribing tripled when zolpidem was added to the VA national formulary in 2008. Buspirone prescribing decreased steadily, while prazosin prescribing expanded nearly 7-fold.

CONCLUSIONS

This work highlights several clinically important trends in prescribing over the past decade among veterans with PTSD that are generally consistent with the revised VA/Department of Defense Clinical Practice Guideline recommendations. However, the findings illustrate the limitations of administrative data and point to a need to supplement this work with a qualitative examination of PTSD prescribing from interviews with providers to better understand the strategies used to make medication management decisions.

Authors+Show Affiliations

National Center for PTSD, Veterans Affairs Medical Center, White River Junction, VT 05001, USA. nancy.bernardy@va.govNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

22490256

Citation

Bernardy, Nancy C., et al. "Prescribing Trends in Veterans With Posttraumatic Stress Disorder." The Journal of Clinical Psychiatry, vol. 73, no. 3, 2012, pp. 297-303.
Bernardy NC, Lund BC, Alexander B, et al. Prescribing trends in veterans with posttraumatic stress disorder. J Clin Psychiatry. 2012;73(3):297-303.
Bernardy, N. C., Lund, B. C., Alexander, B., & Friedman, M. J. (2012). Prescribing trends in veterans with posttraumatic stress disorder. The Journal of Clinical Psychiatry, 73(3), 297-303. https://doi.org/10.4088/JCP.11m07311
Bernardy NC, et al. Prescribing Trends in Veterans With Posttraumatic Stress Disorder. J Clin Psychiatry. 2012;73(3):297-303. PubMed PMID: 22490256.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prescribing trends in veterans with posttraumatic stress disorder. AU - Bernardy,Nancy C, AU - Lund,Brian C, AU - Alexander,Bruce, AU - Friedman,Matthew J, PY - 2011/08/04/received PY - 2011/12/27/accepted PY - 2012/4/12/entrez PY - 2012/4/12/pubmed PY - 2012/6/29/medline SP - 297 EP - 303 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 73 IS - 3 N2 - OBJECTIVE: The revised Department of Veterans Affairs (VA) and Department of Defense Clinical Practice Guideline for Management of Post-Traumatic Stress recommends against long-term use of benzodiazepines to manage posttraumatic stress disorder (PTSD). An analysis of recent trends among veterans receiving care for PTSD in the VA noted a decreasing proportion receiving benzodiazepines. The authors examined prescribing patterns for other medications to better understand the general context in which the changes in benzodiazepine prescribing have occurred in the VA. METHOD: Administrative VA data from fiscal years 1999 through 2009 were used to identify veterans with PTSD using ICD-9 codes extracted from inpatient discharges and outpatient encounters. Prescribing of antidepressants, antipsychotics, and hypnotics was determined for each fiscal year using prescription drug files. RESULTS: The proportion of veterans receiving either of the 2 Clinical Practice Guideline-recommended first-line pharmacotherapy treatments for PTSD, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, increased from 49.7% in 1999 to 58.9% in 2009. In addition to reduced benzodiazepine prescriptions, the overall frequency of antipsychotic use declined 6.1%, from 20.0% in 1999 to 13.9% in 2009. Nonbenzodiazepine hypnotic prescribing tripled when zolpidem was added to the VA national formulary in 2008. Buspirone prescribing decreased steadily, while prazosin prescribing expanded nearly 7-fold. CONCLUSIONS: This work highlights several clinically important trends in prescribing over the past decade among veterans with PTSD that are generally consistent with the revised VA/Department of Defense Clinical Practice Guideline recommendations. However, the findings illustrate the limitations of administrative data and point to a need to supplement this work with a qualitative examination of PTSD prescribing from interviews with providers to better understand the strategies used to make medication management decisions. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/22490256/Prescribing_trends_in_veterans_with_posttraumatic_stress_disorder_ L2 - http://www.psychiatrist.com/jcp/article/pages/2012/v73n03/v73n0302.aspx DB - PRIME DP - Unbound Medicine ER -