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Impact of Atypical Antipsychotic Use on Health Care Utilization in the Elderly

非典型抗精神病药物使用对老年人医疗保健利用的影响

基本信息

批准号：
7661416
负责人：
Rajender R Aparasu
金额：
$ 8.3万
依托单位：
UNIVERSITY OF HOUSTON
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-04-01 至 2011-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7661416
关键词：
Impact Atypical Antipsychotic Use Health

项目摘要

DESCRIPTION (provided by applicant): Atypical antipsychotic agents are widely used for a range of psychiatric disorders in the elderly. However, elderly patients are more susceptible to antipsychotic side effects than adults due to their age-related changes in drug disposition and response. Studies have suggested that elderly are at-risk for cerebrovascular events, metabolic alterations, falls, and movement disorders due to atypical agents. The recent clinical trials revealed that adverse effects limit the usefulness of atypical agents for psychosis, aggression, and agitation in the elderly. These safety and efficacy profiles will have diverse health care consequences in the elderly. However, little is known about health care utilization in elderly patients using antipsychotic agents. This study extends the investigators' prior work to evaluate the heath care impact of antipsychotic use in the elderly. Specific aims of the study are: (1) to describe the use of atypical antipsychotic agents in the elderly; (2) to examine the overall health care use among the elderly using typical and atypical agents; and (3) to compare the overall health care use among the elderly using olanzapine, risperidone, and quetiapine. Using a retrospective cohort design involving elderly Medicare and Medicaid (dual eligible) patients 65 years or older, the proposed study will test the hypotheses that: (i) the overall health care use will be higher among the elderly using atypical agents when compared to those using typical agents; and (ii) the overall health care use differs across atypical antipsychotic agents. Health care use will be evaluated using measures such as hospitalization, outpatient visits, emergency visits, and prescription utilization. The 2001-2003 Medicare and Medicaid claims data from four states with high numbers of dual eligible beneficiaries will be used. The Heckman selection method will be used to adjust for the selection bias within the multivariate context of the Andersen Behavioral Model to examine the health care use associated with atypical agents in the elderly. This investigation will provide valuable information to health care providers and policy makers by addressing the cumulative health care impact of atypical agents due to their safety and efficacy profiles. In addition, the findings will be beneficial in optimizing atypical antipsychotic use and expenditures in the elderly. PUBLIC HEALTH RELEVANCE: With increasing evidence of efficacy and safety concerns of atypical agents, there is a need to evaluate atypical antipsychotic use in the elderly. Little is known about the cumulative health care impact of atypical agents due to their safety and efficacy profiles. An evaluation of health care utilization in the elderly will be valuable to health care providers and policy makers to optimize the use and expenditures of atypical antipsychotic agents in this vulnerable population.

描述(申请人提供)：非典型抗精神病药物被广泛用于治疗老年人的一系列精神障碍。然而，老年患者比成年人更容易出现抗精神病药物的副作用，这是因为他们的药物处置和反应与年龄有关。研究表明，由于非典型药物，老年人有发生脑血管事件、代谢改变、摔倒和运动障碍的风险。最近的临床试验表明，不良反应限制了非典型药物对老年人精神病、攻击性和激动症的有效性。这些安全性和有效性特征将对老年人产生不同的卫生保健后果。然而，对使用抗精神病药物的老年患者的医疗保健利用情况知之甚少。这项研究扩展了研究人员先前的工作，以评估抗精神病药物在老年人中的保健影响。这项研究的具体目的是：(1)描述非典型抗精神病药物在老年人中的使用情况；(2)检查使用典型药物和非典型药物的老年人的总体保健使用情况；以及(3)比较使用奥氮平、利培酮和奎硫平的老年人的总体保健使用情况。采用一项涉及65岁或以上老年Medicare和Medicaid(双重合格)患者的回溯性队列设计，拟议的研究将检验以下假设：(I)与使用典型药物的老年人相比，使用非典型药物的老年人的总体医疗保健使用量更高；以及(Ii)非典型抗精神病药物的总体医疗保健使用量不同。将使用住院、门诊、急诊和处方利用等指标来评估卫生保健使用情况。将使用2001-2003年的联邦医疗保险和医疗补助申领数据，这些数据来自四个拥有大量双重符合条件的受益人的州。Heckman选择方法将被用来调整Andersen行为模型中的多变量背景下的选择偏差，以检查与非典型药物相关的老年人的保健使用。这项调查将为卫生保健提供者和政策制定者提供有价值的信息，解决非典型药物因其安全性和有效性而产生的累积卫生保健影响。此外，这一发现将有助于优化老年人的非典型抗精神病药物的使用和支出。公共卫生相关性：随着越来越多的证据表明非典型药物的有效性和安全性问题，有必要对老年人非典型抗精神病药物的使用进行评估。由于非典型药物的安全性和有效性，人们对非典型药物的累积保健影响知之甚少。对老年人卫生保健利用情况的评估将对卫生保健提供者和政策制定者优化这一弱势群体中非典型抗精神病药物的使用和支出具有重要价值。