Did the COVID-19 Pandemic Affect the Use of Antipsychotics Among Nursing Home Residents With ADRD?
Did the COVID-19 Pandemic Affect the Use of Antipsychotics Among Nursing Home Residents With ADRD?
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DOI：
10.1016/j.jagp.2022.09.009
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发表时间：
2023-02
影响因子：
7.2
通讯作者：
Cai, Shubing
中科院分区：
文献类型：
--
作者：
Yan, Di;Temkin-Greener, Helena;Cai, Shubing
研究 COVID-19 大流行是否以及如何影响疗养院中患有阿尔茨海默病和相关痴呆症的居民抗精神病药物的使用。基于最低数据集和医疗保险索赔的观察性研究。医疗保险和/或医疗补助认证的疗养院。 2017 年至 2020 年间被诊断患有阿尔茨海默病和相关痴呆症的疗养院居民。主要结果变量是一个季度内任何抗精神病药物的使用。次要结果是经过认证的护理助理在一个季度内每天每张床位的工作时间。我们根据疗养院种族和/或民族构成的分布将疗养院分为四分位数。为了探索 COVID-19 大流行与抗精神病药物使用频率之间的关系，我们估计了一个具有稳健标准误、个体和设施随机效应的线性概率模型。我们对认证护理助理的工作时间使用了类似的模型。大约 23.7% 的 ADRD 居民在研究期间使用过抗精神病药物。 2017年第一季度（2017Q1）至2020年第一季度（2020Q1）抗精神病药物使用频率从23.7%–23.1%下降，但到2020年最后一个季度（2020Q4）增加至24.8%。在 COVID-19 大流行期间，所有四个种族和/或族裔群体的居民抗精神病药物的使用都有所增加，但增加的程度因种族和/或民族而异。例如，虽然在大流行开始时，极高少数族裔疗养院的居民比其他疗养院的居民经历了更大的抗精神病药物使用增加，但与低少数族裔疗养院相比，大流行期间高少数族裔疗养院的增长趋势较小（少 0.2 个百分点，p<0.001，基于异方差稳健 t 统计，t = 3.67， df = 8,155,219）。平均而言，认证护理助理的工作时间从2017年第一季度到2020年第一季度每床每天1.8-1.7小时减少，到2020年第四季度进一步减少到每床每天1.5小时。在大流行期间，所有种族和/或族裔群体的工作时间也呈减少趋势。 COVID-19大流行与患有阿尔茨海默病和相关痴呆症的疗养院居民抗精神病药物使用增加以及认证护理助理人员配备减少有关，特别是在少数族裔渗透率较高的疗养院中。未来的研究需要探索减少抗精神病药物使用的方法，特别是在少数族裔居民渗透率较高的家庭中。
To examine whether and how the COVID-19 pandemic affected the use of antipsychotics among residents with Alzheimer's disease and related dementias in nursing homes. Observational study based on the Minimum Data Set and Medicare claims. Medicare- and/or Medicaid-certified nursing homes. Nursing home residents diagnosed with Alzheimer's disease and related dementias between 2017 and 2020. The main outcome variable was any antipsychotic use during a quarter. The secondary outcome was certified nursing assistants’ staffing hours per bed per day in a quarter. We categorized nursing homes into quartiles based on the distribution of nursing home racial and/or ethnic composition. To explore the relationship between the COVID-19 pandemic and the frequency of antipsychotic use, we estimated a linear probability model with robust standard errors, individual and facility random effects. We used a similar model for certified nursing assistant hours. About 23.7% of residents with ADRD had antipsychotic uses during the study period. The frequency of antipsychotic use declined from 23.7%–23.1% between the first quarter of 2017 (2017Q1) and the first quarter of 2020 (2020Q1) but increased to 24.8% by the last quarter of 2020 (2020Q4). Residents in all four racial and/or ethnic groups experienced an increase in antipsychotic use during the COVID-19 pandemic, but the extent of the increase varied by race and/or ethnicity. For example, while residents in the very-high minority nursing homes experienced a greater increase in antipsychotic use than did the residents of other nursing homes at the beginning of the pandemic, the increasing trend during the pandemic was smaller in the very-high minority nursing homes compared to the low-minority nursing homes (0.2 percentage points less, p<0.001, based on heteroskedasticity-robust t statistics, t = 3.67, df = 8,155,219). On average, the certified nursing assistant hours decreased from 1.8–1.7 hours per bed per day between 2017Q1 and 2020Q1, and further decreased to 1.5 hours per bed per day by 2020Q4. There was also a decreasing trend in staffing hours across all racial and/or ethnic groups during the pandemic. The COVID-19 pandemic was associated with an increase in the use of antipsychotics among nursing home residents with Alzheimer's disease and related dementias and decreased staffing of certified nursing assistants, especially among nursing homes with a high minority penetration. Future research is needed to explore means for reducing antipsychotic use, particularly in homes with a high penetration of minority residents.
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影响因子：
5.2
作者：
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通讯作者：
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