Patients' and physicians' characteristics associated with the purchase of benzodiazepines by older primary care patients in Israel.

This study evaluated patients' and physicians' characteristics associated with the purchase of benzodiazepines by older primary care patients in Israel. The analytic sample consists of those 6,421 patients age 65 and older. We used multi-level analysis with whether or not benzodiazepines were purchased at least once between June 2005 and 2007 as an outcome. We also evaluated patients' and physicians' characteristics associated with the purchase of benzodiazepines for 6 months or longer. Almost half the sample (41.5%) purchased benzodiazepines at least once during the study period and more than half (54.5%) of those purchasing benzodiazepines had a continued purchase for 6 months or longer. Physicians' characteristics explained only a small portion of the variance associated with purchasing, whereas patients' demographic and clinical characteristics were associated with purchasing. Any intervention to improve the use of benzodiazepines should be directed at both patients and physicians.

Factors associated with the type of psychotropic medications purchased for common mental disorders in the largest managed care organization in Israel.

OBJECTIVE: To evaluate patient and physician characteristics associated with the type of psychotropic medications (anti-anxiety, antidepressant, or both) purchased. METHODS: The Clalit Health Care Services is the largest managed care health fund in Israel, a country that employs a universal healthcare system. We randomly sampled 30,000 primary care patients over the age of 22 as of January, 2006. RESULTS: Overall, 2,217 purchased either antidepressant or antianxiety medications at least once during the year 2006 and had no prior purchases during the last quarter of 2005. The majority (1,518; 68.4%) purchased only anti-anxiety medications and as many as 264 (12%) purchased both anti-anxiety and antidepressant medications. The remaining 435 (19.6%) patients purchased only antidepressant medications. Physician level characteristics explained only a small portion of the variance and, thus, were not included in further analysis. Several patient level characteristics, including age, somatic, and psychiatric diagnosis were associated with the purchase of different types of medications. CONCLUSIONS: Contrary to clinical guidelines, the purchase of anti-anxiety medications is more prevalent than the purchase of antidepressant medications. In a managed care setting, patient characteristics have a greater role in determining purchasing patterns than provider characteristics; potentially, because of the managed care characteristics that actively guide the care provided to patients.

Characteristics associated with purchasing antidepressant or antianxiety medications through primary care in Israel.

OBJECTIVES: This study analyzed the role of patient and physician characteristics associated with the purchase of antidepressant or antianxiety medications in Israel, a country that has a universal health care system. METHODS: A national sample of 30,000 primary care patients over the age of 22 was randomly drawn from the registry of the largest health care fund in Israel. Data concerning medication purchase between January and December 2006 were extracted. Physician and patient characteristics were merged with Israel's unique identification number. Multilevel analysis was conducted to identify patient- and physician-level predictors of medication purchase. RESULTS: Overall, 19% (N = 4,762) of the sample purchased antidepressant or antianxiety medications. Individuals with greater general medical and psychiatric comorbidity were more likely to purchase antidepressant or antianxiety medications. Older adults, women, those of higher socioeconomic status, and immigrants (with the exception of Jews born in Asia or Africa) were also more likely to purchase medications. Arabs and Jews born in Asia and Africa were less likely to purchase medications even after all other variables were accounted for. Physician characteristics were minimally associated with the purchase of medications. CONCLUSIONS: The findings demonstrate that despite universal health care access, there were variations by population groups. Educational efforts should target patients as well as physicians.

Disparities in antidepressant adherence in primary care: report from Israel.

OBJECTIVES: To evaluate patient and physician characteristics associated with the purchase of antidepressant medication for at least 6 months. STUDY DESIGN AND METHODS: Clalit Health Services is the largest managed care health fund in Israel, a country that uses a universal healthcare system. We randomly sampled 30,000 primary care patients over the age of 22 years. Our analytic sample consisted of those 949 patients who did not purchase antidepressant medication during the last quarter of 2005 and purchased antidepressant medication at least once in 2006. We used multilevel analysis, with whether or not medication was purchased for at least 6 months as an indicator of adherence. Patient and physician characteristics were evaluated as potential predictors. RESULTS: Only 23% of the sample was classified as adherent. Physician characteristics explained only a small portion of the variance in adherence and, as a result, were not included in multivariate analysis. Patients who did not have a somatic diagnosis, had a depression diagnosis, and were of higher socioeconomic status were more likely to be classified as adherent. Patients who purchased tricyclic antidepressants were less likely to be classified as adherent. CONCLUSIONS: The findings suggest that in a managed care setting, there is high uniformity among physicians. Although physician characteristics explain little of the variability associated with adherence, certain patient characteristics as determined by their physicians (eg, antidepressant drug class, psychiatric diagnosis) do play a role in adherence.