Prescribing trends and associated outcomes of antiepileptic drugs and other psychoactive medications in US nursing homes surrounding the COVID-19 pandemic
COVID-19 大流行期间美国疗养院抗癫痫药物和其他精神活性药物的处方趋势和相关结果
基本信息
- 批准号:10446265
- 负责人:
- 金额:$ 70.21万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2022
- 资助国家:美国
- 起止时间:2022-09-01 至 2027-06-30
- 项目状态:未结题
- 来源:
- 关键词:Adverse eventAlzheimer&aposs DiseaseAlzheimer&aposs disease careAlzheimer&aposs disease related dementiaAntiepileptic AgentsAntipsychotic AgentsAttitudeBehaviorBehavioral SymptomsBeliefBlack raceCOVID-19 pandemicCaringCessation of lifeCharacteristicsCognitiveDataData SetDementiaDiagnosisDiagnosticDrug PrescriptionsDrug usageElementsEmergency department visitEpilepsyEventGoalsHealthHome Nursing CareHospital RecordsHospitalizationIndividualKnowledgeLabelLinkMeasuresMedicalMethodsMonitorMoodsNational Institute on AgingNursing HomesOutcomePatientsPatternPharmaceutical PreparationsPilot ProjectsPlanning TheoryPoliciesPopulationPrevalencePsychotropic DrugsResearchResourcesRiskRoleSafetySamplingSurveysSymptomsVulnerable Populationsbasecohortcoronavirus diseasedementia carefallsgender disparityhospice environmentimprovedinnovationneuropsychiatric symptompalliativepandemic diseasepandemic stresspatient orientedpressurepsychological symptomracial disparityresponsestatisticsstressortrend
项目摘要
Since the National Partnership to Improve Dementia Care debuted in 2012 with the goal to reduce antipsychotic use in individuals with Alzheimer’s disease and/or Alzheimer’s-related dementias (AD/ADRD), CMS has scrutinized almost all associated long-stay psychoactive prescribing. While the long-stay use of these monitored psychoactive drugs has declined, prescriptions of mood-stabilizing antiepileptic drugs (AEDs) have increased. Similar to antipsychotics, mood stabilizing AEDs are used to treat the behavioral and psychological symptoms of dementia (BPSD) in the AD/ADRD population. Unlike antipsychotics and other psychoactive medications, AEDs prescribed in nursing homes are not mandatorily reported to CMS. Pilot studies suggest AED increases are concentrated entirely in AD/ADRD and other dementia patients with no diagnosis of epilepsy and purposefully prescribed for BPSD as an unmonitored alternative to antipsychotics. AEDs are not approved to treat AD/ADRD or any dementia symptoms, have weak efficacy evidence, and convey serious risk. Increasingly, the Partnership’s debut seems an inflection point where the trend toward unmonitored alternative drugs for AD/ADRD symptoms sharply increased. Furthermore, initial findings hint that the COVID pandemic represents a second critical point of inflection where the existing transition toward non-superior but unreported drugs for AD/ADRD is again rapidly accelerating. All outcomes associated with this evolving pre-scribing phenomenon remain unknown, though early data warns that harms may be increasing without benefit.
We propose a retrospective analysis detailing long-stay prescribing of all psychoactives, including AEDs, for AD/ADRD and other conditions, how such prescribing is changing under the combined pressures of the pandemic and targeted reduction efforts, and the role of such prescribing in adverse health outcomes. We will accomplish this by creating a detailed dataset of quarterly cohorts of nursing home residents, including those with AD/ADRD, for the years 2009-2021 that draws on elements linked at an individual level from CMS’s Minimum Data Set (MDS), Part D, MedPAR, and Public Use files. The final linked dataset will include health, demographic, cognitive, and diagnostic variables, all psychoactive drug claims, nursing home outcomes, records of hospital and ER adverse events, and long-stay facility details, including staffing resources and COVID statistics. Finally, to help explain and validate findings, a national sampling of nursing home prescribers will be surveyed regarding their knowledge and beliefs surrounding changing approaches to the care of AD/ ADRD and associated outcomes. This study will describe current and evolving AED use in nursing homes for all indications, focusing on AD/ADRD and AD/ADRD outcomes. It will describe racial and gender disparities in the long-stay populations treated or not treated with psychoactives. It will delineate the impact of the COVID pandemic in combination with national policies on ADRD management and outcomes. Results of this study will inform policymakers, improve nursing home care and safety, and introduce new avenues for ongoing research.
自2012年国家改善痴呆症护理合作伙伴关系首次亮相以来,旨在减少阿尔茨海默病和/或阿尔茨海默病相关痴呆症(AD/ADRD)患者中抗精神病药物的使用,CMS已经审查了几乎所有相关的长期精神活性药物处方。虽然这些受监测的精神活性药物的长期使用有所下降,但情绪稳定抗癫痫药物(AED)的处方却有所增加。与抗精神病药类似,情绪稳定型AED用于治疗AD/ADRD人群中的痴呆行为和心理症状(BPSD)。与抗精神病药物和其他精神活性药物不同,养老院开具的AED并不强制报告给CMS。试点研究表明,AED的增加完全集中在AD/ADRD和其他未诊断出癫痫的痴呆患者中,并且有目的地为BPSD开出处方,作为抗精神病药物的未监测替代药物。AED未被批准用于治疗AD/ADRD或任何痴呆症状,疗效证据薄弱,并具有严重风险。越来越多的伙伴关系的首次亮相似乎是一个转折点,在那里的趋势,以不受监测的替代药物的AD/ADRD症状急剧增加。此外,初步研究结果表明,COVID大流行是第二个关键转折点,目前向非优越但未报告的AD/ADRD药物的过渡再次迅速加速。与这种不断演变的预刻现象相关的所有结果仍然未知,尽管早期数据警告说,危害可能会增加而没有好处。
我们提出了一项回顾性分析,详细介绍了AD/ADRD和其他疾病的所有精神活性药物(包括AED)的长期处方,这种处方在大流行和有针对性的减少努力的综合压力下如何变化,以及这种处方在不良健康结果中的作用。我们将通过创建一个详细的养老院居民季度队列数据集来实现这一目标,包括2009-2021年的AD/ADRD患者,该数据集借鉴了CMS最小数据集(MDS),D部分,MedPAR和公共使用文件中在个人层面上链接的元素。最终的关联数据集将包括健康、人口统计学、认知和诊断变量、所有精神活性药物索赔、疗养院结局、医院和急诊室不良事件记录以及长期住院设施详细信息,包括人力资源和COVID统计数据。最后,为了帮助解释和验证研究结果,将对全国范围内的养老院处方者进行抽样调查,了解他们对AD/ ADRD护理方法及其相关结果的认识和信念。本研究将描述目前和不断发展的AED在养老院中用于所有适应症,重点是AD/ADRD和AD/ADRD结局。它将描述在长期停留的人口治疗或不治疗的精神活性物质的种族和性别差异。其将结合国家ADRD管理政策及结果,描述COVID大流行的影响。这项研究的结果将为政策制定者提供信息,改善养老院的护理和安全,并为正在进行的研究引入新的途径。
项目成果
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