Trends in Antipsychotic and Mood Stabilizer Prescribing in Long-Term Care in the U.S.: 2011-2014.
Trends in Antipsychotic and Mood Stabilizer Prescribing in Long-Term Care in the U.S.: 2011-2014.
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DOI：
10.1016/j.jamda.2020.05.039
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发表时间：
2020-11
影响因子：
7.6
通讯作者：
Maust DT
中科院分区：
文献类型：
--
作者：
Gerlach LB;Kales HC;Kim HM;Bynum JPW;Chiang C;Strominger J;Maust DT
医疗保险和医疗补助服务中心改善疗养院痴呆症护理的全国合作伙伴关系重点关注但不限于患有痴呆症的长期护理 (LTC) 居民；对患有其他疾病的居民的潜在影响尚不清楚。我们试图确定居民亚群的抗精神病药物和情绪稳定剂处方是否发生变化。对 20% 医疗保险样本进行重复横断面分析，2011-2014 年。 LTC 中 D 部分承保的按服务付费医疗保险受益人 (n=562,485) 以及仅限于抑郁症或双相情感障碍患者的二次分析 (n=139,071)。主要结果是每季度使用抗精神病药物或情绪稳定剂治疗的预测概率。从2011年至2014年，抗精神病药物治疗的调整预测概率（APP）从0.120（95%置信区间[CI] 0.119-0.121）下降至0.100（95% CI 0.099-0.101；p<0.001）。所有年龄、性别和种族/族裔群体的使用量均下降；痴呆症患者的下降幅度更大（p<0.001）。情绪稳定剂使用的 APP 从 0.140 (95% CI 0.139–0.141) 增长到 0.185 (95% CI 0.184–0.186)，在非痴呆症患者中增长幅度略大 (p<0.001)。在抑郁症或双相情感障碍患者中，抗精神病药物治疗的 APP 从 0.081 (95% CI 0.079–0.082) 增加至 0.087 (95% CI 0.085–0.088；p<0.001)；情绪稳定剂治疗的 APP 增长更多，从 0.193 (95% CI 0.190–0.196) 到 0.251 (0.248–0.253；p<0.001)。喹硫平是最常用的抗精神病药物。最广泛使用的心境稳定剂是加巴喷丁，截至 2014 年底，70.5% 的接受心境稳定剂治疗的患者使用了加巴喷丁。对于患有抑郁症或双相情感障碍的居民来说，抗精神病药和心境稳定剂治疗的可能性并未下降，对于他们来说，这种处方可能是合适的，但他们没有被排除在合作伙伴的抗精神病药质量衡量之外。情绪稳定剂的使用广泛增长，这在很大程度上是由加巴喷丁处方的增长推动的。在 CMS 改善痴呆症护理全国合作伙伴关系之后，我们发现痴呆症患者抗精神病药物处方的减少幅度最大，而在抑郁症或双相情感障碍患者中则没有发现，这些患者可能适合使用抗精神病药物。
The Centers for Medicare & Medicaid Services’ National Partnership to Improve Dementia Care in Nursing Homes focuses on but is not limited to long-term care (LTC) residents with dementia; the potential impact on residents with other diagnoses is unclear. We sought to determine whether resident subpopulations experienced changes in antipsychotic and mood stabilizer prescribing. Repeated cross-sectional analysis of a 20% Medicare sample, 2011–2014. Fee-for-service Medicare beneficiaries with Part D coverage in LTC (n=562,485) and a secondary analysis limited to persons with depression or bipolar disorder (n=139,071). Main outcome was quarterly predicted probability of treatment with an antipsychotic or mood stabilizer. From 2011–2014, the adjusted predicted probability (APP) of antipsychotic treatment fell from 0.120 (95% confidence interval [CI] 0.119–0.121) to 0.100 (95% CI 0.099–0.101; p<0.001). Use decreased for all age, sex, and racial/ethnic groups; the decline was larger for persons with dementia (p<0.001). The APP of mood stabilizer use grew from 0.140 (95% CI 0.139–0.141) to 0.185 (95% CI 0.184–0.186), growth slightly larger among persons without dementia (p<0.001). Among persons with depression or bipolar disorder, the APP of antipsychotic treatment increased from 0.081 (95% CI 0.079–0.082) to 0.087 (95% CI 0.085–0.088; p<0.001); APP of mood stabilizer treatment grew more, from 0.193 (95% CI 0.190–0.196) to 0.251 (0.248–0.253; p<0.001). Quetiapine was the most commonly prescribed antipsychotic. The most widely prescribed mood stabilizer was gabapentin, prescribed to 70.5% of those who received a mood stabilizer by the end of 2014. The likelihood of antipsychotic and mood stabilizer treatment did not decline for residents with depression or bipolar disorder, for whom such prescribing may be appropriate but who were not excluded from the Partnership’s antipsychotic quality measure. Growth in mood stabilizer use was widespread, and largely driven by growth in gabapentin prescribing. Following the CMS National Partnership to Improve Dementia Care, we found that reductions in antipsychotic prescribing were greatest among patients with dementia and not seen among patients with depression or bipolar disorder, where use may be appropriate.
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影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
3.4
作者：
Olivieri-Mui, Brianne L.;Devlin, John W.;Briesacher, Becky
通讯作者：
Briesacher, Becky
DOI：
10.1136/bmj.e977
发表时间：
2012-02-23
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Huybrechts KF;Gerhard T;Crystal S;Olfson M;Avorn J;Levin R;Lucas JA;Schneeweiss S
通讯作者：
Schneeweiss S
DOI：
10.1007/s10742-010-0060-4
发表时间：
2010-06-01
影响因子：
1.5
作者：
Yun, Huifeng;Kilgore, Meredith L.;Locher, Julie L.
通讯作者：
Locher, Julie L.
影响因子：
7
作者：
Gustafsson, Maria;Sandman, Per-Olof;Lovheim, Hugo
通讯作者：
Lovheim, Hugo