Impact of COVID-19 on Continuity of Care for Veterans on Antipsychotic Medications

COVID-19 对退伍军人抗精神病药物护理连续性的影响

• 批准号: 10538353
• 负责人: ANOUK L GRUBAUGH
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10538353
• 关键词: Address; Adherence; Administrator; Admission activity; Age; Age of Onset; Agranulocytosis; Antipsychotic Agents; Area; Attitude; Behavior; Bipolar Disorder; Blood Glucose; Blood Pressure; COVID-19; COVID-19 impact; Caring; Chronic; Chronic Disease; Clinical; Clozapine; Code; Continuity of Patient Care; Data; Data Sources; Diabetes Mellitus; Diagnostic; Disease; Drug Prescriptions; Emergency Care; Emergency Situation; Ethnic Origin; Event; Fasting; Future; Gender; Generations; Guidelines; Health; Health Personnel; Healthcare; Healthcare Systems; Heart; Heart Diseases; Individual; Inpatients; Interruption; Interview; Knowledge; Lipids; Malignant Neoplasms; Mental Health; Mental disorders; Metabolic; Methodology; Methods; Military Personnel; Monitor; Nurse Practitioners; Outcome; Outpatients; Patients; Pharmaceutical Preparations; Pharmacists; Population; Provider; Psychiatrist; Public Health; Race; Research Design; Resistance; Rural; Safety; Schizophrenia; Services; Statistical Methods; Suggestion; Suicide; Suicide prevention; System; Testing; Veterans; Visit; Weight; Woman; care outcomes; cohort; cost; economic impact; ethnic minority; experience; health care availability; health care delivery; health care service utilization; heart function; hospital readmission; insight; military veteran; mortality; multiple data sources; neutrophil; non-compliance; obesity risk; patient population; pharmacy benefit; post-COVID-19; prevent; racial minority; racial population; relapse prevention; rural area; severe mental illness; side effect; symptom management; urban dwelling

Background: Severe mental illnesses are consistently ranked as some of the most debilitating health conditions worldwide due to their early age of onset, chronicity, and impact on functioning. Fortunately, a number of antipsychotic medications have been found to be effective for managing the symptoms of severe mental illness (SMI) and for preventing relapse and rehospitalization. Despite their efficacy, treatment non-compliance for individuals on these medications is high due to a number of factors including poor insight into illness, negative attitudes about medication, and medication related side effects. Further complicating care and outcomes for this clinical population, providers must maintain close oversight of patients on antipsychotics due to the impact of these medications on metabolic and cardiac functioning which confer an increased risk of obesity, diabetes, heart problems, and other chronic illnesses. This oversight includes regular monitoring of weight, blood pressure, fasting blood glucose, and lipid levels. Additionally, clozapine, indicated for treatment-resistant schizophrenia, requires weekly-to-monthly monitoring of absolute neutrophil counts to prevent potentially fatal clozapine- induced agranulocytosis. Significance: The proposed project has significant and immediate relevance to Veterans and the VHA in that it seeks to better understand if and to what extent COVID-19 related care disruptions impacted care and outcomes for Veterans with SMI prescribed antipsychotic medications. Given pre- existing challenges in the treatment of this Veteran population, this is an important area of inquiry as well as one for which little is known. Added strengths of the proposed study include the use of a mixed methods approach that includes national level data from multiple sources. Aside from addressing a critical knowledge gap, the proposed study targets what is unarguably one of the most vulnerable patient populations within the VA and other healthcare systems—patients with SMI prescribed antipsychotic medications. Specific Aims: Aim 1: To assess the impact of COVID-19 related care disruptions on healthcare use and outcomes for Veterans on antipsychotic medications using robust statistical methods and national level data; Aim 2: To assess whether the impact of COVID-19 related care disruptions differ by race/ethnicity, gender, age, and rural/urban status using national level data; Aim 3: To conduct thematic interviews with provider and patient stakeholder groups at the national level to better understand COVID-19 related care disruptions. Provider stakeholders (e.g., psychiatrists, advanced nurse practitioners) will be interviewed to better understand COVID-19 related changes in practice behaviors, the perceived impact of these changes on care continuity and outcomes, and to solicit suggestions to mitigate the impact of interrupted care in the future; Veterans prescribed antipsychotic medication prescriptions in the pre COVID-19 window will be interviewed to better understand the impact of COVID-19 related care disruptions on treatment seeking behaviors, obstacles encountered with regard to access, and to explore other factors potentially impacting outcomes in this patient group. Methodology: The proposed study will employ a mixed-methods (quantitative/qualitative) approach. For Aims 1 & 2 we will employ retrospective, observational analyses using a national cohort of Veterans (N>250,000) with an ICD-CM-10 diagnostic code for schizophrenia or bipolar disorder prescribed a first-generation or second-generation antipsychotic [1/19-12/21]. Veterans of all ages, genders, racial groups, military eras will be included in the cohort. Aim 3 will involve individual thematic interviews with provider (n=35-45) and patient stakeholders (n=50-60). Next Steps/Implementation: Findings from this 2-year project will be of immediate relevance and impact for local, regional, and national level administrators and mental health providers as well as the VA Office of Mental Health and Suicide Prevention and VA Pharmacy Benefits Management Services. Collectively, data from this project will serve to identify potential strategies to further mitigate the impact of COVID-19 on the care and outcomes of Veterans with SMI as well as prepare for future public health and/or other national emergencies.

背景：严重的精神疾病一直被列为一些最衰弱的健康状况 由于其发病年龄早、慢性化和对功能的影响，幸运的是， 抗精神病药物已被发现是有效的管理症状的严重精神疾病 (SMI)以及预防复发和再住院。尽管他们的疗效，治疗不遵守， 由于许多因素，包括对疾病的了解不佳， 对药物的态度，以及药物相关的副作用。进一步复杂化的护理和结果， 临床人群，提供者必须保持对患者的抗精神病药物的密切监督，由于影响， 这些药物对代谢和心脏功能的影响增加了肥胖，糖尿病， 心脏问题和其他慢性疾病。这种监督包括定期监测体重，血压， 空腹血糖和血脂水平。此外，氯氮平，适用于难治性精神分裂症， 需要每周至每月监测中性粒细胞绝对计数，以防止潜在的致命性氯氮平- 引起粒细胞缺乏症。重要性：拟议的项目具有重大和直接的相关性， 退伍军人和VHA，因为它试图更好地了解是否以及在多大程度上与COVID-19相关的护理 中断影响护理和结果的退伍军人与SMI处方抗精神病药物。鉴于前- 在治疗退伍军人群体方面存在的挑战，这是一个重要的调查领域， 对此知之甚少。拟议研究的其他优势包括使用混合方法 其中包括来自多个来源的国家一级数据。除了解决关键的知识差距外， 拟议的研究针对的是VA中无可争议的最脆弱的患者人群之一， 其他医疗保健系统-患有SMI的患者处方抗精神病药物。具体目标：目标1： 评估COVID-19相关护理中断对退伍军人医疗保健使用和结果的影响， 抗精神病药物使用稳健的统计方法和国家水平的数据;目的2：评估是否 COVID-19相关护理中断的影响因种族/民族、性别、年龄和城乡状况而异， 目标3：在国家一级对提供者和患者利益相关者群体进行专题访谈， 国家层面，以更好地了解COVID-19相关的护理中断。提供商利益相关者（例如，精神病学家， 高级执业护士）将接受采访，以更好地了解COVID-19相关的实践变化 行为，这些变化对护理连续性和结果的影响，并征求建议 以减轻未来中断护理的影响;退伍军人处方抗精神病药物 将对COVID-19前窗口期的处方进行访谈，以更好地了解COVID-19的影响 寻求治疗行为的相关护理中断，在获得治疗方面遇到的障碍，以及 探索可能影响该患者组结局的其他因素。方法：拟议的研究 将采用混合方法（定量/定性）。对于目标1和2，我们将采用回顾性方法， 观察性分析使用了一个国家退伍军人队列（N> 250，000），使用ICD-CM-10诊断代码， 精神分裂症或双相情感障碍患者处方第一代或第二代抗精神病药[1/19-12/21]。 所有年龄，性别，种族群体，军事时代的退伍军人将被纳入队列。目标3将涉及 与提供者（n=35-45）和患者利益相关者（n=50-60）进行个人主题访谈。下 步骤/实施：这个为期2年的项目的结果将对当地， 地区和国家一级的管理人员和精神卫生提供者以及退伍军人事务部精神卫生办公室 自杀预防和VA药房福利管理服务。总的来说，这个项目的数据 将有助于确定潜在的战略，以进一步减轻COVID-19对护理和结果的影响， 患有SMI的退伍军人以及为未来的公共卫生和/或其他国家紧急情况做好准备。