Addressing Behavior and Mood in Assisted Living: Organizational Characteristics Related to the Use of Antipsychotic and Psychotropic Medications and Alternative Practices

 描述（由申请人提供）：使用抗精神病药物和其他精神药物来解决长期护理机构中老年人的行为和情绪问题已成为全国关注的问题。2011年，24%的疗养院居民接受抗精神病药物治疗，尽管联邦食品和药物管理局发布了强烈的“黑盒警告”，警告其危及生命的不良反应风险，以及有效的非药物替代品的可用性。作为回应，2012年，医疗保险和医疗补助服务中心发起了一项全国性的倡议，迄今为止已经将养老院中抗精神病药物的使用减少了17%。新出现的证据表明，为近75万老年人提供护理的辅助生活住宅（ALR）也值得严重关注。70%的辅助生活居民有认知障碍，38%有行为症状，25%有抑郁症状。新的数据表明，69%的ALR定期服用药物来控制行为，57%有行为症状的居民服用药物-包括42%没有认知障碍的人和46%只有轻度认知障碍的人。此外，在超过20%的ALR中，无执照的工作人员管理药物，并且这些相同的个人确定何时应管理“按需”（prore nata; PRN）药物。因此，对辅助生活中的抗精神病药物处方的关注已成为许多组织关注的焦点，这并不奇怪。尽管值得关注和国家的关注，有抗精神病药物和其他精神药物在ALR的实际使用的信息不足，几乎没有信息的设置中，他们最有可能被使用和实施基于证据的替代护理的可行性。因此，不可能制定政策和基准，以促进更好的护理，因为现在正在发生在养老院。作为回应，该项目由临床和健康服务专家在辅助生活研究中进行-由ALR政策，法规，实践，教育和宣传的国家和州领导人组成的咨询委员会的密切参与-将获得和传播信息，以帮助利益相关者了解问题的范围并促进变革。具体而言，在美国两个地区的7个州的280名ALR的分层随机样本中，发现处方率最高和最低，拟议的研究将确定（1）抗精神病药物和其他精神药物使用的范围和模式;（2）与药物使用和潜在不适当处方相关的组织和个人水平特征;以及（3）正在使用的或可行的替代策略，以解决居民的痛苦。它还将（4）向实践、政策和宣传利益攸关方传播结果。假设抗精神病药物和其他精神药物的使用，以及实施循证、非药理学实践的能力，将与对政策和实践有影响的可改变的组织特征有关。

 DESCRIPTION (provided by applicant): The use of antipsychotic and other psychotropic medications to address behavior and mood among older adults residing in long-term care settings has become a national concern. In 2011, 24% of nursing home residents received antipsychotic medications, despite strong "black box warnings" issued by the federal Food and Drug Administration of their risk of life-threatening adverse effects, as well as the availability f effective non-pharmacological alternatives. In response, in 2012 the Centers for Medicare & Medicaid Services launched a national initiative that to date has reduced antipsychotic use in nursing homes by 17 percent. Emerging evidence suggests grave cause for concern in assisted living residences (ALRs) as well, which provide care for almost 750,000 older adults. Seventy percent of assisted living residents have cognitive impairment, 38% have behavioral symptoms, and 25% have symptoms of depression. New data indicate that 69% of ALRs regularly administer medication to control behavior, and 57% of residents with behavioral symptoms are prescribed a medication - including 42% who have no cognitive impairment and 46% who have only mild cognitive impairment. Further, unlicensed staff administer medications in more than 20% of ALRs, and these same individuals determine when an "as needed" (pro re nata; PRN) medication should be administered. It is no surprise, then, that concern about antipsychotic prescribing in assisted living has become a focus of attention for numerous organizations. Despite notable concern and national attention, there is insufficient information about the actual use of antipsychotic and other psychotropic drugs in ALRs, and virtually no information regarding the settings in which they are most likely to be used and the feasibility of implementing evidence-based alternatives to care. Consequently, it is not possible to develop policies and benchmarks to promote better care as is now occurring in nursing homes. In response, this project, conducted by clinical and health services experts in assisted living research - with close involvement of an advisory board composed of national and state leaders in ALR policy, regulation, practice, education, and advocacy - will obtain and disseminate information to help stakeholders understand the scope of the problem and promote change. Specifically, in a stratified random sample of 280 ALRs across seven states in two regions of the country noted to have the highest and lowest prescribing rates, the proposed study will ascertain (1) the scope and patterns of antipsychotic and other psychotropic medication use; (2) organizational and person-level characteristics related to medication use and potentially inappropriate prescribing; and (3) alternate strategies in use or feasible to address resident distress. It also will (4) disseminate the results to practice, policy, and advocacy stakeholders. t is hypothesized that antipsychotic and other psychotropic medication use, as well as the capacity to implement evidence-based, non-pharmacological practices, will relate to modifiable organizational characteristics that have implications for policy and practice.