Antipsychotic prescribing in care homes before and after launch of a national dementia strategy: an observational study in English institutions over a 4-year period.
Antipsychotic prescribing in care homes before and after launch of a national dementia strategy: an observational study in English institutions over a 4-year period.
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DOI：
10.1136/bmjopen-2015-009882
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发表时间：
2016-09-20
期刊：
影响因子：
2.9
通讯作者：
Bowman C
中科院分区：
文献类型：
--
作者：
Szczepura A;Wild D;Khan AJ;Owen DW;Palmer T;Muhammad T;Clark MD;Bowman C
评估英国国家痴呆症战略（NDS）的启动与长期住院护理（LTC）中抗精神病药物处方之间的关联。使用电子药物管理系统的信息，对616家长期护理机构（31 619名居民）在推出NDS后的处方模式进行回顾性分析。NDS发布后4年内，LTC设置中所有居民的抗精神病药处方点患病率（PP）。次要结果包括推荐的第二代抗精神病药（SGAs）与第一代抗精神病药（FGA）的剂量、治疗时间和使用。探讨了设施级PP值与机构特征、居民人口统计学之间的关联。研究了不同地理区域的差异。计算处方净成分成本。在4年期间的总体处方率中未观察到统计学显著差异（Kolmogorov-Smirnov（KS）检验p=0.60），并且没有向新的SGA发生显著变化（KS检验p=0.32）。仅1.3%的病例剂量高于最大指示剂量，但69.7%的病例处方持续时间过长。处方量最高的五分之一的护理院更有可能位于贫困地区（率比（Q5/Q1）RR=5.89，95% CI 4.35 - 7.99），登记为痴呆（RR=3.38，95%CI 3.06至3.73），最低五分位数的患者更有可能由单一全科医生（GP）提供服务（RR=0.48; 95% CI 0.37至0.63）; p<0.001。不同地理区域之间的PP水平有六倍的差异。抗精神病药物的平均年支出为每人65.6英镑（2012年价格）。在英格兰的NDS与降低的PP水平或在护理之家的抗精神病药物处方类型无关。需要进一步的研究来探索原因。可能需要明确的标准，规定推荐的药物，剂量和治疗时间，以及常规监测和抗精神病药物处方的更大责任。
To assess associations between the launch of the National Dementia Strategy (NDS) and antipsychotic prescribing in long-term residential care (LTC) in England. Retrospective analysis of prescribing patterns in 616 LTC institutions (31 619 residents) following launch of the NDS, using information from electronic medicines management system. Antipsychotic prescribing point prevalence (PP) for all residents in a cross section of LTC settings over a 4-year period following NDS launch. Secondary outcomes included dosages, length of treatment and use of recommended second-generation antipsychotics (SGAs) versus first-generation antipsychotics (FGAs). Associations between facility-level PP values and institutional characteristics, resident demographics were explored. Variations across geographical areas examined. Prescription net ingredient costs calculated. No statistically significant difference was observed in overall prescribing rates over the 4-year period (Kolmogorov-Smirnov (KS) test p=0.60), and there was no significant shift towards newer SGAs (KS test p=0.32). Dosages were above the maximum indicated in only 1.3% of cases, but duration of prescribing was excessive in 69.7% of cases. Care homes in the highest prescribing quintile were more likely to be located in a deprived area (rate ratio (Q5/Q1) RR=5.89, 95% CI 4.35 to 7.99), registered for dementia (RR=3.38, 95% CI 3.06 to 3.73) and those in the lowest quintile were more likely to be served by a single general practitioner (GP) practice (RR=0.48; 95% CI 0.37 to 0.63); p<0.001 all. A sixfold variation in PP levels was observed between geographical areas. The average annual expenditure on antipsychotics was £65.6 per person resident (2012 prices). The NDS in England was not associated with reduced PP levels or the types of antipsychotic prescribing in care homes. Further research is needed to explore why. Clear standards specifying recommended agents, dosages and length of treatment, together with routine monitoring and greater accountability for antipsychotic prescribing, may be required.
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