Antipsychotic Use in Hospitalized Adults: Rates, Indications, and Predictors
Antipsychotic Use in Hospitalized Adults: Rates, Indications, and Predictors
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DOI：
10.1111/jgs.13943
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发表时间：
2016-02-01
影响因子：
6.3
通讯作者：
Marcantonio, Edward R.
中科院分区：
文献类型：
--
作者：
Herzig, Shoshana J.;Rothberg, Michael B.;Marcantonio, Edward R.
目的调查住院成人使用抗精神病药物的模式和预测因素。设计回顾性队列研究。设置学术医疗中心。年龄在18岁及以上的患者，从2012年8月至2013年8月住院，不包括那些被收进妇产科或精神科或精神病患者。测量使用从药房收费确定。使用长期护理机构指南定义了潜在过量给药。100个记录进行了审查，以确定use.ResultsThe队列的原因包括17,775入院的中位年龄64;个人可能已经承认在研究期间超过一次。抗精神病药物的使用率为9%，其中55%是首次使用。最常见的启动原因是谵妄（53%）和可能的谵妄（12%）。16%的住院患者暴露于抗精神病药物，可能发生过量给药。在开始服用抗精神病药物的住院患者中，26%的患者出院后服用这些药物。与启动相关的特征包括年龄75岁及以上（相对风险（RR）=1.4，95%置信区间（CI）=1.2-1.7），男性（RR=1.2，95% CI=1.1-1.4），黑人（RR=0.8，95% CI=0.6-0.96），谵妄（RR=4.8，95% CI=4.2-5.7），痴呆（RR=2.1，95% CI=1.7-2.6），入院接受医疗服务（RR=1.2，95% CI=1.1-1.4）、重症监护室停留（RR=2.1，95% CI= 1.8-2.4）和机械通气（RR=2.0，95% CI= 1.7-2.4）。在开始服用抗精神病药物的个体中，与出院相关的特征是年龄在75岁及以上（RR=0.6，95% CI=0.4-0.7），出院至家中以外的任何地点（RR=2.5，95% CI=1.8-3.3）和住院抗精神病药物暴露的类别（RR=1.6，95%CI =1.1-2.3为非典型vs典型; RR=2.7，95%CI =1.9-3.8为两个vs典型）。结论抗精神病药物的启动和使用是常见的住院期间，最常见的谵妄，和个人经常出院对这些药物。确定了出院时使用的几个预测因素，提出了用于促进审议持续必要性的决策支持工具的潜在目标。
ObjectivesTo investigate patterns and predictors of use of antipsychotics in hospitalized adults.DesignRetrospective cohort study.SettingAcademic medical center.ParticipantsIndividuals aged 18 and older hospitalized from August 2012 to August 2013, excluding those admitted to obstetrics and gynecology or psychiatry or with a psychotic disorder.MeasurementsUse was ascertained from pharmacy charges. Potentially excessive dosing was defined using guidelines for long-term care facilities. A review of 100 records was performed to determine reasons for use.ResultsThe cohort included 17,775 admissions with a median age 64; individuals could have been admitted more than once during the study period. Antipsychotics were used in 9%, 55% of which were initiations. The most common reasons for initiation were delirium (53%) and probable delirium (12%). Potentially excessive dosing occurred in 16% of admissions exposed to an antipsychotic. Of admissions with antipsychotic initiation, 26% were discharged on these medications. Characteristics associated with initiation included age 75 and older (relative risk (RR)=1.4, 95% confidence interval (CI)=1.2-1.7), male sex (RR=1.2, 95% CI=1.1-1.4), black race (RR=0.8, 95% CI=0.6-0.96), delirium (RR=4.8, 95% CI=4.2-5.7), dementia (RR=2.1, 95% CI=1.7-2.6), admission to a medical service (RR=1.2, 95% CI=1.1-1.4), intensive care unit stay (RR=2.1, 95% CI= 1.8-2.4), and mechanical ventilation (RR=2.0, 95% CI= 1.7-2.4). In individuals who were initiated on an antipsychotic, characteristics associated with discharge on antipsychotics were age 75 and older (RR=0.6, 95% CI=0.4-0.7), discharge to any location other than home (RR=2.5, 95% CI=1.8-3.3), and class of in-hospital antipsychotic exposure (RR=1.6, 95% CI=1.1-2.3 for atypical vs typical; RR=2.7, 95% CI=1.9-3.8 for both vs typical).ConclusionAntipsychotic initiation and use were common during hospitalization, most often for delirium, and individuals were frequently discharged on these medications. Several predictors of use on discharge were identified, suggesting potential targets for decision support tools that would be used to prompt consideration of ongoing necessity.