Evaluating the impact of Choosing Wisely Canada recommendations on the overuse and inappropriate use of psychiatric medications among young people

Introduction: The Choosing Wisely Canada (CWC) campaign aims to facilitate discussion between patients and providers about what procedures, tests, and treatments are unnecessary. The results of previous evaluations of the CWC recommendations on the use of unnecessary care from various specialties, however, are not consistent. This thesis aims to build upon the previous body of research by evaluating the impact of the CWC recommendations regarding the appropriate prescription of psychiatric medications for young people. Specifically, I assessed the impact of three specific recommendations on the drug utilization, time to treatment, and costs. Methods: To evaluate the impact of the CWC recommendations on the use psychiatric medications among young people in British Columbia, I identified all patients with incident diagnoses and prescription fills for the recommendations under study: selective serotonin reuptake inhibitors (SSRIs) among adolescents (<=17) with major depressive disorder (MDD), psychostimulants among preschool aged children (<=5) with attention deficit and hyperactivity disorder (ADHD), and atypical antipsychotics (AAs) among ADHD patients comorbid with disruptive behaviour disorders (DBDs) (no age restriction). Using comprehensive administrative data from 2010 to 2017 and interrupted time series analyses, I assessed longitudinal trends in relevant outcomes for each recommendation, including the incidence of disease, prescription drug starting, and time to treatment initiation following a new diagnosis. Results: For MDD, the CWC recommendations did not change the level or trend in monthly depression incidence, starting SSRIs, and the time to SSRI treatment. Similarly, following the release of the recommendation for ADHD, the incidence of ADHD, number of stimulant starters, and time to treatment initiation did not change among preschool aged children. Finally, for antipsychotic use among ADHD/DBDs there was a significant trend increase in the number of starters who initiated treatment within 7 months, but these results were based on a very small sample size. Conclusion: I did not find that the CWC campaign had a major impact on the inappropriate use of psychiatric medications in target populations. This is consistent with the existing literature that public campaigns alone are insufficient to change clinical practice in this area.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat