Nursing Home Characteristics Associated with High and Low Levels of Antipsychotic, Benzodiazepine, and Opioid Prescribing to Residents with Alzheimer's Disease and Related Dementias: A Cross-Sectional Analysis.
Nursing Home Characteristics Associated with High and Low Levels of Antipsychotic, Benzodiazepine, and Opioid Prescribing to Residents with Alzheimer's Disease and Related Dementias: A Cross-Sectional Analysis.
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DOI：
10.1016/j.jamda.2022.05.025
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发表时间：
2022-11
影响因子：
7.6
通讯作者：
Maust, Donovan T.
中科院分区：
文献类型：
--
作者：
Candon, Molly;Strominger, Julie;Gotlieb, Evelyn;Maust, Donovan T.
我们研究了养老院（NH）的特征与养老院对患有阿尔茨海默病及相关痴呆症（ADRD）的居民开具抗精神病药、苯二氮䓬类药物或阿片类药物的水平高低之间的关联。然后我们测量了抗精神病药高（低）处方量的养老院同时也是苯二氮䓬类药物或阿片类药物高（低）处方量的可能性。
一项回顾性横断面分析。
样本包括2017年居住在13151家养老院的448128名被诊断患有ADRD的医疗保险受益人。
利用医疗保险索赔数据、最小数据集和长期护理焦点（LTCFocus），我们测量了2017年开具1次及以上抗精神病药、苯二氮䓬类药物或阿片类药物处方的ADRD养老院居民的比例。使用带有州聚类标准误的线性概率模型，我们确定了哪些养老院特征与每种药物类别处方分布的最高（最低）四分位数相关。最后，我们测量了处于抗精神病药处方量最高（最低）四分位数的养老院是否更有可能处于苯二氮䓬类药物或阿片类药物处方量的最高（最低）四分位数。
在各个养老院中，平均有29.1%的ADRD居民接受了抗精神病药，30.2%接受了苯二氮䓬类药物，40.9%接受了阿片类药物。规模较小的养老院以及 Medicaid参保居民比例较大的养老院更有可能是处方量最高四分位数的养老院；拥有更多注册护理服务的养老院更有可能是处方量最低四分位数的养老院。抗精神病药处方与苯二氮䓬类药物处方密切相关，但与阿片类药物处方无关。
抗精神病药和苯二氮䓬类药物处方之间的重叠，以及我们发现一些养老院特征在不同药物类别处方中始终相关，可能支持养老院存在一种处方的组织文化这一观点，这可以为提高养老院处方质量的努力提供信息。我们的研究结果还凸显了ADRD患者使用苯二氮䓬类药物和阿片类药物的情况，在养老院中，这些药物比抗精神病药更常被开具，但受到的监管关注较少。
一些养老院的特征与对痴呆症居民开具抗精神病药、苯二氮䓬类药物和阿片类药物的高低水平始终相关，这可能表明存在一种处方的组织文化。
We examined the association between nursing home (NH) characteristics and whether NHs had high or low levels of antipsychotic, benzodiazepine, or opioid prescribing to residents with Alzheimer’s Disease and related dementias (ADRD). We then measured the likelihood that NHs who were high (low) prescribers of antipsychotics were also high (low) prescribers of benzodiazepines or opioids. A retrospective, cross-sectional analysis. The sample included 448,128 Medicare beneficiaries diagnosed with ADRD, who resided in 13,151 NHs in 2017. Using Medicare claims, the Minimum Data Set, and LTCFocus, we measured the share of NH residents with ADRD who filled 1+ antipsychotic, benzodiazepine, or opioid prescription in 2017. Using linear probability models with state-clustered standard errors, we identified which NH characteristics were associated with being in the top (bottom) quartile of the prescribing distribution for each drug class. Finally, we measured whether NHs who were top-quartile (bottom-quartile) antipsychotic prescribers were more likely to be top-quartile (bottom-quartile) benzodiazepine or opioid prescribers. Across NHs, an average of 29.1% of residents with ADRD received an antipsychotic, 30.2% received a benzodiazepine, and 40.9% received an opioid. Smaller NHs and NHs with a larger share of Medicaid-enrolled residents were more likely to be top-quartile prescribers; NHs with more registered nursing care were more likely to be bottom-quartile prescribers. Antipsychotic prescribing tracked closely with benzodiazepine prescribing, but not opioid prescribing. The overlap between antipsychotic and benzodiazepine prescribing and our finding that some NH characteristics were consistently associated with prescribing across drug classes may support the idea of an organizational culture of prescribing in NHs, which could inform efforts to improve prescribing quality in NHs. Our results also highlight benzodiazepine and opioid use for ADRD, which were more commonly prescribed than antipsychotics in NHs but have received less regulatory attention. Some nursing home characteristics are consistently associated with high and low levels of antipsychotic, benzodiazepine, and opioid prescribing to residents with dementia, which may suggest the presence of an organizational culture of prescribing.
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