Geographic Variation of Antidementia and Antipsychotic Medication Use Among US Nursing Home Residents With Dementia.

IF 4.3 3区材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC

ACS Applied Electronic Materials Pub Date : 2024-08-01 Epub Date: 2024-05-29 DOI:10.1097/MLR.0000000000002016

Alison Rataj, Matthew Alcusky, Jonggyu Baek, Brian Ott, Kate L Lapane

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Abstract

Background: Several antidementia medications have been approved for symptomatic treatment of cognitive and functional impairment due to Alzheimer disease. Antipsychotics are often prescribed off-label for behavioral symptoms.

Objective: The aim of this study was to describe the basis for regional variation in antidementia and antipsychotic medication use.

Setting: US nursing homes (n=9735), hospital referral regions (HRR; n=289).

Subjects: Long-stay residents with dementia (n=273,004).

Methods: Using 2018 Minimum Data Set 3.0 linked to Medicare data, facility information, and Dartmouth Atlas files, we calculated prevalence of use and separate multilevel logistic models [outcomes: memantine, cholinesterase inhibitor (ChEI), antipsychotic use] estimated adjusted odds ratios (aOR) and 95% CIs for resident, facility, and HRR characteristics. We then fit a series of cross-classified multilevel logistic models to estimate the proportional change in cluster variance (PCV).

Results: Overall, 20.9% used antipsychotics, 16.1% used memantine, and 23.3% used ChEIs. For antipsychotics, facility factors [eg, use of physical restraints (aOR: 1.08; 95% CI: 1.05-1.11) or poor staffing ratings (aOR: 1.10; 95% CI: 1.06-1.14)] were associated with more antipsychotic use. Nursing homes in HRRs with the highest health care utilization had greater antidementia drug use (aOR memantine: 1.68; 95% CI: 1.44-1.96). Resident/facility factors accounted for much regional variation in antipsychotics (PCV STATE : 27.80%; PCV HRR : 39.54%). For antidementia medications, HRR-level factors accounted for most regional variation (memantine PCV STATE : 37.44%; ChEI PCV STATE : 39.02%).

Conclusion: Regional variations exist in antipsychotic and antidementia medication use among nursing home residents with dementia suggesting the need for evidence-based protocols to guide the use of these medications.

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美国养老院痴呆症患者使用抗痴呆和抗精神病药物的地域差异。

背景：多种抗痴呆药物已被批准用于阿尔茨海默病引起的认知和功能障碍的对症治疗。抗精神病药物通常在标签外用于治疗行为症状：本研究旨在描述抗痴呆和抗精神病药物使用的地区差异基础：美国养老院（n=9735）、医院转诊地区（HRR；n=289）：患有痴呆症的长期住院者（n=273004人）.方法：使用2018年最小数据集3.0.0：利用与医疗保险数据、设施信息和达特茅斯地图集文件相连接的 2018 年最低数据集 3.0，我们计算了使用率，并分别建立了多层次逻辑模型[结果：美金刚、胆碱酯酶抑制剂 (ChEI)、抗精神病药的使用]，估算了居民、设施和 HRR 特征的调整赔率比 (aOR) 和 95% CI。然后，我们拟合了一系列交叉分类多层次逻辑模型，以估计群组方差的比例变化（PCV）：总体而言，20.9%的人使用了抗精神病药物，16.1%的人使用了美金刚，23.3%的人使用了ChEIs。就抗精神病药物而言，设施因素[例如，使用物理约束（aOR：1.08；95% CI：1.05-1.11）或人员配备评级较差（aOR：1.10；95% CI：1.06-1.14）]与使用抗精神病药物较多有关。医疗保健利用率最高的 HRRs 地区的护理院使用的抗痴呆药物较多（aOR memantine：1.68；95% CI：1.44-1.96）。居民/机构因素在抗精神病药物的使用上造成了很大的地区差异（PCVSTATE：27.80%；PCVHRR：39.54%）。就抗痴呆药物而言，HRR 水平因素造成的地区差异最大（美金刚 PCVSTATE：37.44%；ChEI PCVSTATE：39.02%）：结论：在患有痴呆症的养老院居民中，抗精神病药物和抗痴呆药物的使用存在地区差异，这表明有必要制定循证方案来指导这些药物的使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Electronic Materials Multiple-

CiteScore

7.20

自引率

4.30%

发文量

567