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

描述（由申请人提供）：非典型抗精神病药物广泛用于老年人的一系列精神疾病。然而，老年患者比成年人更容易发生抗精神病药物副作用，这是由于他们在药物处置和反应方面的年龄相关变化。研究表明，老年人由于非典型因素而有发生脑血管事件、代谢改变、福尔斯和运动障碍的风险。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、攻击性和激越的有效性。这些安全性和有效性特征将对老年人产生不同的医疗保健后果。然而，很少有人知道医疗保健利用老年患者使用抗精神病药物。这项研究扩展了研究者先前的工作，以评估老年人使用抗精神病药物对健康护理的影响。本研究的具体目的是：（1）描述非典型抗精神病药物在老年人中的使用情况;（2）检查使用典型和非典型药物的老年人的总体医疗保健使用情况;（3）比较使用奥氮平、利培酮和奎替鲁的老年人的总体医疗保健使用情况。使用回顾性队列设计，涉及65岁或以上的老年医疗保险和医疗补助（双重合格）患者，拟议的研究将检验以下假设：（i）与使用典型药物的患者相比，使用非典型药物的老年人的整体医疗保健使用率较高;（ii）非典型抗精神病药物的整体医疗保健使用率不同。将使用住院、门诊访视、急诊访视和处方使用等指标评价医疗保健使用情况。将使用来自四个州的2001-2003年医疗保险和医疗补助索赔数据，这些州有大量的双重合格受益人。Heckman选择方法将用于调整Andersen行为模型多变量背景下的选择偏倚，以检查老年人中与非典型药物相关的医疗保健使用。这项调查将提供有价值的信息，卫生保健提供者和政策制定者通过解决累积的医疗保健影响的非典型代理人，由于其安全性和有效性的档案。此外，研究结果将有利于优化非典型抗精神病药物的使用和老年人的支出。 公共卫生相关性：随着越来越多的证据表明非典型药物的疗效和安全性问题，有必要评估非典型抗精神病药物在老年人中的使用。由于非典型药物的安全性和有效性，其累积的医疗保健影响知之甚少。评估老年人的卫生保健利用情况，将有助于卫生保健提供者和政策制定者优化非典型抗精神病药物在这一弱势群体中的使用和支出。

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.