Antipsychotic prescribing as a treatment of dementia in British Columbia: physician-level characteristics associated with receiving potentially inappropriate prescriptions

Abstract

Antipsychotic prescribing has increased. One attribute of this is off-label prescribing of antipsychotics to people with dementia to treat behavioural and psychological symptoms, which is not supported by evidence-informed guidelines. This manuscript investigated physician-level factors associated with prescribing antipsychotics to community-dwelling adults with dementia by primary care physicians in British Columbia. Most physician variables were not associated with a patient being dispensed an antipsychotic. A physician’s years in practice was significantly associated with a patient’s risk of receiving an antipsychotic. Patients who received an antipsychotic were older, had lower incomes, used more prescriptions, contacted a physician more, and had higher comorbidity scores compared to patients who did not receive an antipsychotic. Rarity of outcomes, decreased rate of antipsychotic prescriptions, and little indication of practice-variation indicated physicians appropriately prescribe antipsychotics to patients with dementia. Future studies should investigate career-variation, apply similar methodology in regions of Canada, and investigate qualitative factors associated with antipsychotic prescribing at the physician- and patient/caregiver-level.