Study raises questions about prescription practices in Manitoba

A recent study released by the Manitoba Centre for Health Policy on prescription practices in Manitoba has led to concerns that optimal prescription practices are not always being used.

The study, which looked at prescription practices from 1997-2008, found that patients suffering from asthma were being prescribed long-acting beta antagonists (LABA) without first being prescribed an inhaled corticosteroid. According to the report, the risk of side effects increases without the steroid.

“We found that both patient and prescriber factors predicted less than optimal prescribing. Asthma patients are less likely to be prescribed asthma medications according to guidelines if they have less severe asthma, or see general practitioners instead of specialists,” said Colette Raymond, a pharmacist with the Winnipeg Regional Health Authority (WRHA) and lead researcher for the study.

Raymond stressed that there were other contributing factors that were not covered by the study that could explain these results. The prescription of atypical, also known second-generation, antipsychotics was found most often to be dependent on patient factors.

The study also found that users of high-dose antipsychotics were younger and more likely to be male, have psychosis or dementia, and be taking fewer other medications. “No prescriber or environment characteristics predicted this less than optimal prescribing,” explained Raymond.

The antipsychotic prescription concerns were made public when leader of the provincial Liberal party, Jon Gerrard, demanded an investigation of prescription practices in personal care homes after the study was released.

David G. Strang, chief medical officer at Deer Lodge Centre and acting director of geriatrics for the WRHA’s rehab/geriatrics program, explained that the second-generation antipsychotics that the study was examining had only been recently approved in 1997, and thus the increase of their prescription was not out of order.

“We are not using antipsychotics as a restraint for patients,” said Strang.
As well, Strang pointed out that the study did not include all the personal care homes in Manitoba, such as Deer Lodge. He said that Raymond had included this information in her study, but that, for whatever reason, this was not reported.

The study did find that prescriptions for the drug metformin, used to treat Type 2 diabetes, has increased over time, accounting for more than 82 per cent of the first prescription for patients by 2008-09.

However, Raymond was hopeful that the results would lead policymakers, other professionals in the industry, and patients to engage in a dialogue about optimal prescription practices in Manitoba.

“For the most part, we were expecting to find what we did find. It is great news,” said Raymond.