UCI-RCOC

NEURODEVELOPMENTAL PROGRAM AND CLINIC

A 14 Year ReviewFebruary 2, 2012

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

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

Psychoactive Drug Psychoactive Drug SurveySurvey

30 months consecutive data

CalOptima Pharmacy Billing Records Accessed

Cross-linked to RCOC consumers

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

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?

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

Adherence by Residence Adherence by Residence TypeType

Cross linked adherence calculations with residence type

from CDER

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

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

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)

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.

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

INTERDISCIPLINARY INTERDISCIPLINARY CLINICCLINIC

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

Primary Referral ReasonsPrimary Referral Reasons

Polypharmacy

Medication side effects

Increasing behavioral problems

Need for diagnostic services

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

Age Distribution of Clinic Age Distribution of Clinic PopulationPopulation

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

Level of Intellectual DisabilityLevel of Intellectual Disability

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

Number of Psychoactive Number of Psychoactive Medications Medications Pre-Pre-ClinicClinic

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

Top 25 Medications Pre-Top 25 Medications Pre-ClinicClinic

Major Psychiatric Diagnostic Major Psychiatric Diagnostic CategoriesCategories

Diagnostic Trends by YearDiagnostic Trends by Year

Significant increase in consumers with an Anxiety Disorder or Autistic Disorder

Diagnostic Trends by YearDiagnostic Trends by Year

Significant decrease in consumers with Bipolar Disorder, OCD, or Impulse Control Disorder

DIFFERENCES DIFFERENCES BETWEEN BETWEEN DISORDERSDISORDERS

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)

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

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

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)