Janet K. Sluggett, Gillian E. Caughey, Tracy Air, Monica Cations, Catherine E. Lang, Stephanie A. Ward, Susannah Ahern, Xiaoping Lin, Kasey Wallis, Maria Crotty, Maria C. Inacio
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This study aimed to develop a CQI for antipsychotic use >90 days and examine trends, associated factors, and variation in CQI incidence; and examine duration of the first episode of use among individuals with dementia accessing home care packages (HCPs) or PRAC.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Retrospective cohort study, including older individuals with dementia who accessed HCPs (<i>n</i> = 50,257) or PRAC (<i>n</i> = 250,196). Trends in annual CQI incidence (2011–12 to 2015–16) and associated factors were determined using Poisson regression. Funnel plots examined geographical and facility variation. Time to antipsychotic discontinuation was estimated among new antipsychotic users accessing HCP (<i>n</i> = 2367) and PRAC (<i>n</i> = 15,597) using the cumulative incidence function.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Between 2011–12 and 2015–16, antipsychotic use for >90 days decreased in HCP recipients from 10.7% (95% CI 10.2–11.1) to 10.1% (95% CI 9.6–10.5, adjusted incidence rate ratio (aIRR) 0.97 (95% CI 0.95–0.98)), and in PRAC residents from 24.5% (95% CI 24.2–24.7) to 21.8% (95% CI 21.5–22.0, aIRR 0.97 (95% CI 0.96–0.98)). Prior antipsychotic use (both cohorts) and being male and greater socioeconomic disadvantage (PRAC cohort) were associated with higher CQI incidence. Little geographical/facility variation was observed. Median treatment duration in HCP and PRAC was 334 (interquartile range [IQR] 108–958) and 555 (IQR 197–1239) days, respectively.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>While small decreases in antipsychotic use >90 days were observed between 2011–12 and 2015–16, findings suggest antipsychotic use among aged care recipients with dementia can be further minimized.</p>\n </section>\n </div>","PeriodicalId":14060,"journal":{"name":"International Journal of Geriatric Psychiatry","volume":"39 5","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/gps.6089","citationCount":"0","resultStr":"{\"title\":\"National surveillance using a clinical quality indicator for prolonged antipsychotic use among older Australians with dementia who access aged care services\",\"authors\":\"Janet K. Sluggett, Gillian E. 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引用次数: 0
摘要
目标 痴呆症指南建议只有在非药物干预无效时才使用抗精神病药物来治疗行为和心理症状，并定期检查使用情况。针对永久性老年寄宿护理机构（PRAC）痴呆症护理的人群临床质量指标（CQI）通常监测抗精神病药物的使用率，但不监测长期使用情况。本研究旨在制定抗精神病药物使用 90 天的 CQI，并检查 CQI 发生率的趋势、相关因素和变化；同时检查使用家庭护理套餐（HCPs）或 PRAC 的痴呆患者首次使用的持续时间。 方法 回顾性队列研究，包括使用家庭护理包（50257 人）或 PRAC（250196 人）的老年痴呆患者。采用泊松回归法确定了年度 CQI 发生率趋势（2011-12 年至 2015-16 年）和相关因素。漏斗图检验了地域和设施的差异。使用累积发生率函数估算了访问 HCP（n = 2367）和 PRAC（n = 15597）的抗精神病药物新用户停用抗精神病药物的时间。 结果 2011-12年至2015-16年期间，HCP接受者90天内使用抗精神病药的比例从10.7%（95% CI 10.2-11.1）降至10.1%（95% CI 9.6-10.5，调整后发病率比（aIRR）0.97（95% CI 0.95-0.98）），PRAC居民从24.5%（95% CI 24.2-24.7）降至21.8%（95% CI 21.5-22.0，aIRR 0.97（95% CI 0.96-0.98））。曾使用抗精神病药物（两个队列）、男性和社会经济地位较低（PRAC队列）与较高的CQI发生率相关。观察到的地域/机构差异很小。HCP 和 PRAC 的中位治疗时间分别为 334 天（四分位数间距 [IQR] 108-958）和 555 天（IQR 197-1239）。 结论 虽然在 2011-12 年至 2015-16 年期间，抗精神病药物的使用 >90 天数略有减少，但研究结果表明，可以进一步最大限度地减少痴呆症老年护理对象中抗精神病药物的使用。
National surveillance using a clinical quality indicator for prolonged antipsychotic use among older Australians with dementia who access aged care services
Objectives
Dementia guidelines recommend antipsychotics are only used for behavioral and psychological symptoms when non-drug interventions fail, and to regularly review use. Population-level clinical quality indicators (CQIs) for dementia care in permanent residential aged care (PRAC) typically monitor prevalence of antipsychotic use but not prolonged use. This study aimed to develop a CQI for antipsychotic use >90 days and examine trends, associated factors, and variation in CQI incidence; and examine duration of the first episode of use among individuals with dementia accessing home care packages (HCPs) or PRAC.
Methods
Retrospective cohort study, including older individuals with dementia who accessed HCPs (n = 50,257) or PRAC (n = 250,196). Trends in annual CQI incidence (2011–12 to 2015–16) and associated factors were determined using Poisson regression. Funnel plots examined geographical and facility variation. Time to antipsychotic discontinuation was estimated among new antipsychotic users accessing HCP (n = 2367) and PRAC (n = 15,597) using the cumulative incidence function.
Results
Between 2011–12 and 2015–16, antipsychotic use for >90 days decreased in HCP recipients from 10.7% (95% CI 10.2–11.1) to 10.1% (95% CI 9.6–10.5, adjusted incidence rate ratio (aIRR) 0.97 (95% CI 0.95–0.98)), and in PRAC residents from 24.5% (95% CI 24.2–24.7) to 21.8% (95% CI 21.5–22.0, aIRR 0.97 (95% CI 0.96–0.98)). Prior antipsychotic use (both cohorts) and being male and greater socioeconomic disadvantage (PRAC cohort) were associated with higher CQI incidence. Little geographical/facility variation was observed. Median treatment duration in HCP and PRAC was 334 (interquartile range [IQR] 108–958) and 555 (IQR 197–1239) days, respectively.
Conclusions
While small decreases in antipsychotic use >90 days were observed between 2011–12 and 2015–16, findings suggest antipsychotic use among aged care recipients with dementia can be further minimized.
期刊介绍：
The rapidly increasing world population of aged people has led to a growing need to focus attention on the problems of mental disorder in late life. The aim of the Journal is to communicate the results of original research in the causes, treatment and care of all forms of mental disorder which affect the elderly. The Journal is of interest to psychiatrists, psychologists, social scientists, nurses and others engaged in therapeutic professions, together with general neurobiological researchers.
The Journal provides an international perspective on the important issue of geriatric psychiatry, and contributions are published from countries throughout the world. Topics covered include epidemiology of mental disorders in old age, clinical aetiological research, post-mortem pathological and neurochemical studies, treatment trials and evaluation of geriatric psychiatry services.
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