The quality of antipsychotic drug prescribing in nursing homes
The quality of antipsychotic drug prescribing in nursing homes
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DOI：
10.1001/archinte.165.11.1280
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发表时间：
2005-06-13
影响因子：
--
通讯作者：
Stuart, B
中科院分区：
文献类型：
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作者：
Briesacher, BA;Limcangco, R;Stuart, B
背景资料：抗精神病药物的处方一直在增加，因为第二代抗精神病药物，也被称为药物的可用性，在疗养院（NH），但有关于这种prescription.Methods的适当性的信息很少：一项回顾性分析，使用具有全国代表性的数据集合并到最小数据集评估，药物管理记录，医疗保险索赔的医疗保险当前受益调查。我们在2000-2001年期间确定了250万名国家卫生机构医疗保险受益人的样本（未加权n = 1096）评估抗精神病药物使用的患病率、NH处方指南的依从率和行为症状的变化。约693 000人（未加权n = 302），或27.6%，所有医疗保险受益人在研究期间接受至少一个抗精神病药物处方：20.3%只接受治疗药物; 3.7%，仅为传统; 3.6%，既是传统又是传统。根据NH处方指南，不到一半（41.8%）的接受治疗的居民接受抗精神病药物治疗。1/4例患者（23.4%）没有适当的适应症，17.2%的患者日剂量超过推荐水平，17.6%的患者适应症不适当且剂量过高。接受抗精神病药物治疗的患者在指南内没有更多的可能实现稳定或改善行为症状比那些服用抗精神病药物以外的guidelines.Conclusions：这项研究检测到的最高水平的抗精神病药物的使用在NHs在十多年。大多数药物的处方超出了处方指南，剂量和适应症没有强有力的临床证据。未能检测到行为症状和抗精神病药物治疗之间的正相关关系，提出了关于处方的适当性的问题。
Background: The prescribing of antipsychotic drugs has been increasing in nursing homes (NHs) since the availability of second-generation antipsychotic agents, also known as the atypicals, but there is little information on the appropriateness of such prescribing.Methods: A retrospective analysis using the nationally representative data set of the Medicare Current Beneficiary Survey merged to Minimum Data Sets assessments, medication administration records, and Medicare claims. We identified a sample of 2.5 million Medicare beneficiaries in NHs during 2000-2001 (unweighted n = 1096) to assess prevalence of antipsychotic use, rates of adherence to NH prescribing guidelines, and changes in behavioral symptoms.Results: Approximately 693 000 (unweighted n = 302), or 27.6%, of all Medicare beneficiaries in NHs received at least 1 prescription for antipsychotics during the study period: 20.3% received atypicals only; 3.7%, conventionals only; and 3.6%, both atypicals and conventionals. Less than half (41.8%) of treated residents received antipsychotic therapy in accordance with NH prescribing guidelines. One (23.4%) in 4 patients had no appropriate indication, 17.2% had daily doses exceeding recommended levels, and 17.6% had both inappropriate indications and high dosing. Patients receiving antipsychotic therapy within guidelines were no more likely to achieve stability or improvement in behavioral symptoms than were those taking antipsychotics outside the guidelines.Conclusions: This study detected the highest level of antipsychotic use in NHs in over a decade. Most atypicals were prescribed outside the prescribing guidelines and for doses and indications without strong clinical evidence. Failure to detect positive relationships between behavioral symptoms and antipsychotic therapy raises questions about the appropriateness of prescribing.