Neuroleptic drug therapy in older adults newly admitted to nursing homes: Incidence, dose, and specialist contact
Neuroleptic drug therapy in older adults newly admitted to nursing homes: Incidence, dose, and specialist contact
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DOI：
10.1111/j.1532-5415.2004.52212.x
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发表时间：
2004-05-01
影响因子：
6.3
通讯作者：
Rochon, PA
中科院分区：
文献类型：
--
作者：
Bronskill, SE;Anderson, GM;Rochon, PA
目的：描述新近为入住疗养院的老年人进行行为障碍的抗精神病药物治疗的发生率和剂量，并确定这种使用是否与患者特征和与专家的接触有关。设计：一项回顾性队列研究，使用来自综合性和通用药物计划的管理数据。背景：加拿大安大略省所有有执照的疗养院。参与者：所有 19,780 名 66 岁及以上的成年人，他们在过去一年中没有使用抗精神病药物的证据，无严重精神病史，并于 1998 年 4 月 1 日至 2000 年 3 月 31 日期间新住进疗养院。测量：使用提交给安大略省药物福利计划的索赔来测量抗精神病药物治疗的暴露情况和初始剂量。结果：在入住疗养院后 1 年内，100 天内向 17% 以前未曾接触过抗精神病药物的老年人开出了抗精神病药物治疗处方，24% 的老年人在入院后 1 年内向其中 24% 开出了抗精神病药物治疗处方。女性中新接触抗精神病药物的可能性较小（比值比 (OR)=0.7，95% 置信区间 (CI)=0.6-0.8），而痴呆症居民的可能性较高（OR=3.5，95% CI=3.2-3.8）。近 10% 的疗养院居民接受的初始剂量超过了推荐阈值。在新接触的人中，只有 14% 之前曾与老年科医生或精神科医生接触过。结论：安大略省疗养院使用抗精神病药物的事件相当多。高剂量的使用表明一些医生可能需要有关使用这些药物的更好信息，特别是考虑到非典型抗精神病药物疗法的迅速采用。
OBJECTIVES: To describe the incidence and dose of neuroleptic drug therapy newly dispensed for behavioral disorders to older adults admitted to nursing homes and to determine whether this use is associated with patient characteristics and contact with specialists.DESIGN: A retrospective cohort study using administrative data from a comprehensive and universal drug program.SETTING: All licensed nursing homes in Ontario, Canada.PARTICIPANTS: All 19,780 adults aged 66 and older who had no evidence of neuroleptic drug use in the previous year and no history of major psychosis and were newly admitted to a nursing home between April 1, 1998, and March 31, 2000.MEASUREMENTS: Exposure to neuroleptic drug therapy and initial dose were measured using claims submitted to the Ontario Drug Benefit Program.RESULTS: A prescription for a neuroleptic therapy was dispensed to 17% of older adults with no previous neuroleptic exposure within 100 days and to 24% within 1 year of their nursing home admission. New exposure to a neuroleptic therapy was less likely in women (odds ratio (OR)=0.7, 95% confidence interval (CI)=0.6-0.8) and more likely in residents with dementia (OR=3.5, 95% CI=3.2-3.8). Almost 10% of nursing home residents received an initial dose that exceeded recommended thresholds. Only 14% of those newly exposed had prior contact with a geriatrician or psychiatrist.CONCLUSION: Incident use of neuroleptics in Ontario nursing homes is substantial. Use of high doses suggests that some physicians may need better information about using these agents, particularly given the rapid adoption of atypical neuroleptic drug therapies.