Patterns of Dementia Treatment and Frank Prescribing Errors in Older Adults With Parkinson Disease.
Patterns of Dementia Treatment and Frank Prescribing Errors in Older Adults With Parkinson Disease.
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DOI：
10.1001/jamaneurol.2018.2820
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发表时间：
2019-01-01
期刊：
影响因子：
29
通讯作者：
Willis AW
中科院分区：
文献类型：
--
作者：
Mantri S;Fullard M;Gray SL;Weintraub D;Hubbard RA;Hennessy S;Willis AW
痴呆症在帕金森病(PD)中很常见，但关于痴呆症的治疗模式或同时使用胆碱酯酶抑制剂(ACHEI)和抗胆碱能药物(ACH)的数据很少，这是一个明显的处方错误。确定痴呆症治疗的流行率，并量化和表征帕金森病患者中不适当使用高效ACH(ACHHigh)药物和ACHEI的情况。这项横断面分析包括2014年美国联邦医疗保险处方计划的参与者，他们被诊断为帕金森病。我们的主要结果是(1)痴呆症药物的处方填写(2)ACHEI和ACHHigh药物的伴随处方填写。描述性分析和多变量Logistic回归模型确定了患者特征和共病情况与痴呆治疗或ACHHigh-ACHEI事件相关的程度。268,407名被诊断为帕金森病的联邦医疗保险受益人符合纳入标准；73,093人(27.2%)至少开了一种抗痴呆药物。最常见的药物是多奈哌齐(n=46,027，占使用者的63.0%)，其次是美金刚(n=30,578，41.8%)、利瓦斯汀(n=19,278，26.4%)。与白人相比，痴呆症药物更有可能开给黑人(调整后的优势比[AOR]1.33，95%可信区间[CI]1.28-1.38)和西班牙裔(AOR 1.28，95%CI 1.22-1.35)，而不太可能开给美洲原住民(AOR 0.62，95%CI 0.51-0.74)。女性服用痴呆症药物的可能性较小(与男性相比，AOR为0.85，95%CI为0.84-0.87)。在接受ACHEI治疗的64,017名PD患者中，44.5%(n=28,495)至少有一次ACHHigh-ACHEI事件。拉美裔(AOR 1.11，95%CI 1.00-1.23)和女性(AOR 1.30，95%CI 1.25-1.35)有更大的几率发生这种永远不会发生的事件。在美国南部和中西部，这种处方错误的流行率有统计学意义的聚集性(Moran‘s i=0.24；p<；0.001)，聚集性高的ACH-ACHEI流行率。帕金森病患者的痴呆症药物使用因种族和性别而异。潜在的不适当处方在接受认知障碍治疗的PD患者中很常见，并因种族、性别和地理位置而有很大差异。这些数据为改善帕金森病患者的护理质量和结果提供了国家和地方目标。
Dementia is common in Parkinson disease (PD), but there is little data on dementia treatment patterns or the concomitant use of cholinesterase inhibitors (ACHEI) and anticholinergic medications (ACH), a frank prescribing error. To determine the prevalence of dementia treatment and to quantify and characterize inappropriate administration of a high-potency ACH (ACHhigh) drug and an ACHEI among persons with PD. This cross-sectional analysis included participants in the U.S. Medicare Prescription Program in 2014 diagnosed with Parkinson Disease. Our primary outcomes were (1) prescription fill for a dementia drug (2) concomitant prescription fills for an ACHEI and an ACHhigh drug. Descriptive analyses and multivariable logistic regression models determined the extent to which patient characteristics and comorbid conditions were associated with dementia treatment or with an ACHhigh-ACHEI event. 268,407 Medicare beneficiaries diagnosed with PD met inclusion criteria; 73,093 (27.2%) were prescribed at least one anti-dementia medication. The commonest medication was donepezil (n=46,027; 63.0% of users) followed by memantine (n=30,578, 41.8%), rivastigmine (n=19,278, 26.4%). Compared to whites, dementia medications were more likely to be prescribed to Blacks (adjusted odds ratio [AOR] 1.33, 95% confidence interval [CI] 1.28–1.38) and Hispanics (AOR 1.28, 95%CI 1.22–1.35) and less likely to be prescribed to Native Americans (AOR 0.62, 95%CI 0.51–0.74). Women were less likely to be prescribed a dementia medication (AOR 0.85, 95%CI 0.84–0.87, compared to men). Of the 64,017 PD patients receiving an ACHEI, 44.5% (n=28,495) had at least one ACHhigh-ACHEI event. Hispanics (AOR 1.11, 95%CI 1.00–1.23) and women (AOR 1.30, 95%CI 1.25–1.35) had greater odds of this ‘never event’. There was statistically significant clustering in the prevalence of this prescribing error (Moran’s I = 0.24; p < 0.001), with clusters of high ACHhigh-ACHEI prevalence in the Southern and Midwestern United States. Dementia medication use varies by race and sex among persons with PD. Potentially inappropriate prescribing is common among PD patients being treated for cognitive impairment, and varies substantially by race, sex and geography. These data provide national and local targets for improving care quality and outcomes for persons with PD.
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DOI：
10.1097/phh.0b013e3182a3e958
发表时间：
2014-07-01
影响因子：
3.3
作者：
Erdem, Erkan;Korda, Holly;Sennett, Cary
通讯作者：
Sennett, Cary
影响因子：
2.1
作者：
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通讯作者：
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DOI：
10.1016/j.pnpbp.2017.11.004
发表时间：
2018-03-02
影响因子：
5.6
作者：
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通讯作者：
Jonsson, Erik G.
影响因子：
4.1
作者：
Campbell NL;Perkins AJ;Bradt P;Perk S;Wielage RC;Boustani MA;Ng DB
通讯作者：
Ng DB
影响因子：
2.6
作者：
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通讯作者：
Harbishettar, Vijay