Department of Primary and Community Care,Centre for Family Medicine,Geriatric Care and Public Health,Radboud University Medical Centre,Nijmegen,the Netherlands.
Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research,VU Medical Center,Amsterdam,the Netherlands.
Int Psychogeriatr. 2016 Oct;28(10):1589-95. doi: 10.1017/S104161021600082X. Epub 2016 May 31.
This study explores the appropriateness of psychotropic drug (PD) use for neuropsychiatric symptoms (NPS) in nursing home patients with dementia.
A cross-sectional study on 559 patients with dementia residing on dementia special care units in Dutch nursing homes was conducted. Appropriateness of PD use was assessed using the Appropriate Psychotropic drug use In Dementia (APID) index. The APID index score is calculated using information about individual PDs from patients' medical records. The index encompasses seven (different) domains of appropriateness, i.e. indication, evaluation, dosage, drug-drug interactions, drug-disease interactions, duplications, and therapy duration.
A total of 578 PDs were used for NPS by 60% of the nursing home patients. Indication, evaluation, and therapy duration contributed the most to inappropriate use. Ten per cent of the PDs scored fully appropriate according to the APID index sum score, 36% scored fully appropriate for indication, 46% scored fully appropriate for evaluation, and 58% scored fully appropriate for therapy duration. Antidepressants were used the most appropriately, and antiepileptics the most inappropriately.
The minority of the PD use was fully appropriate. The results imply that PD use for NPS in dementia can be improved; the appropriateness should be optimized with a clinical focus on the appropriate indications, evaluations, and therapy duration.
本研究旨在探讨在患有痴呆症的养老院患者中，精神药物（PD）用于治疗神经精神症状（NPS）的适宜性。
对荷兰养老院痴呆特殊护理病房的 559 名痴呆症患者进行了横断面研究。使用适当的精神药物在痴呆症中的使用（APID）指数评估 PD 使用的适宜性。APID 指数评分是根据患者病历中有关个体 PD 的信息计算得出的。该指数涵盖了七个（不同）适宜性领域，即适应症、评估、剂量、药物相互作用、药物-疾病相互作用、重复用药和治疗持续时间。
共有 578 种 PD 用于治疗 60%的养老院患者的 NPS。适应症、评估和治疗持续时间对不适当使用的影响最大。根据 APID 指数总分，10%的 PD 完全符合适宜性标准，36%的 PD 完全符合适应症标准，46%的 PD 完全符合评估标准，58%的 PD 完全符合治疗持续时间标准。抗抑郁药的使用最适宜，而抗癫痫药的使用最不恰当。
少数 PD 的使用是完全适宜的。研究结果表明，痴呆症中 NPS 的 PD 使用可以得到改善；应优化其适宜性，重点关注适当的适应症、评估和治疗持续时间。
