按性别和种族分列的痴呆症医疗保险受益人的神经精神并发症和精神药物使用情况。

IF 2.9 4区 医学 Q2 CLINICAL NEUROLOGY
Kim G Johnson, Cassie Ford, Amy G Clark, Melissa A Greiner, Jay B Lusk, Cody Perry, Richard O'Brien, Emily C O'Brien
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引用次数: 0

摘要

背景:神经精神症状影响着大多数痴呆症患者。过去的研究报告显示,在这一人群中,精神药物处方可能不当的比例很高。我们调查了美国当地队列中神经精神科诊断和精神药物处方在性别和种族上的差异:我们利用医疗保险报销单和处方填写记录,对 2017 年年龄在 50 岁及以上、诊断为痴呆症的 100%医疗保险北卡罗来纳州和南卡罗来纳州受益人进行队列研究。我们使用经过验证的编码算法识别痴呆症并量化焦虑症、抑郁症和精神病的诊断。我们搜索医疗保险报销单中的抗焦虑、抗抑郁和抗精神病药物,以确定处方:结果:白人患者中焦虑症和抑郁症的诊断率较高;黑人患者中精神病的诊断率较高(P < .001)。(P<0.001)女性被诊断为焦虑症、抑郁症和精神病的比例高于男性(P<0.001),所服用的抗焦虑和抗抑郁药物也多于男性(P<0.001)。(P<0.001)黑人和其他种族患者服用抗精神病药物治疗焦虑、抑郁和精神病的比例高于白人患者。(在所有患者和诊断中,抗抑郁药物的处方率均高于抗焦虑或抗精神病药物(P < .001)。在没有神经精神疾病诊断的患者中,11.4% 的患者处方了抗焦虑药,22.8% 的患者处方了抗抑郁药,7.6% 的患者处方了抗精神病药:老年痴呆症患者,尤其是女性患者,抗焦虑(苯二氮卓)药物的高填充率令人担忧。给患者开精神药物的比例很高。这种做法可能是不恰当的处方。通过创新的社区宣传和护理服务模式对患者/护理人员进行教育,可能有助于减少药物的使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neuropsychiatric Comorbidities and Psychotropic Medication Use in Medicare Beneficiaries With Dementia by Sex and Race.

Background: Neuropsychiatric symptoms affect the majority of dementia patients. Past studies report high rates of potentially inappropriate prescribing of psychotropic medications in this population. We investigate differences in neuropsychiatric diagnoses and psychotropic medication prescribing in a local US cohort by sex and race.

Methods: We utilize Medicare claims and prescription fill records in a cohort of 100% Medicare North and South Carolina beneficiaries ages 50 and above for the year 2017 with a dementia diagnosis. We identify dementia and quantify diagnosis of anxiety, depression and psychosis using validated coding algorithms. We search Medicare claims for antianxiety, antidepressant and antipsychotic medications to determine prescriptions filled.

Results: Anxiety and depression were diagnosed at higher rates in White patients; psychosis at higher rates in Black patients. (P < .001) Females were diagnosed with anxiety, depression and psychosis at higher rates than males (P < .001) and filled more antianxiety and antidepressant medications than males. (P < .001) Black and Other race patients filled more antipsychotic medications for anxiety, depression and psychosis than White patients. (P < .001) Antidepressants were prescribed at higher rates than antianxiety or antipsychotic medications across all patients and diagnoses. Of patients with no neuropsychiatric diagnosis, 11.4% were prescribed an antianxiety medication, 22.8% prescribed an antidepressant and 7.6% prescribed an antipsychotic.

Conclusions: The high fill rate of antianxiety (benzodiazepine) medications in dementia patients, especially females is a concern. Patients are prescribed psychotropic medications at high rates. This practice may represent potentially inappropriate prescribing. Patient/caregiver education with innovative community outreach and care delivery models may help decrease medication use.

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来源期刊
CiteScore
6.20
自引率
0.00%
发文量
40
审稿时长
>12 weeks
期刊介绍: Journal of Geriatric Psychiatry and Neurology (JGP) brings together original research, clinical reviews, and timely case reports on neuropsychiatric care of aging patients, including age-related biologic, neurologic, and psychiatric illnesses; psychosocial problems; forensic issues; and family care. The journal offers the latest peer-reviewed information on cognitive, mood, anxiety, addictive, and sleep disorders in older patients, as well as tested diagnostic tools and therapies.
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