Judith A. Lucas (
John R. Bowblis is an associate professor and Endres Fellow in the Department of Economics and Research Fellow with the Scripps Gerontology Center at Miami University, in Oxford, Ohio.
Health Aff (Millwood). 2017 Jul 1;36(7):1299-1308. doi: 10.1377/hlthaff.2016.1439.
The Centers for Medicare and Medicaid Services initiated three strategies (in March and July 2012 and in May 2013) to reduce the use of unnecessary antipsychotic medications in nursing homes, especially their widespread use to control behavioral symptoms of dementia. We examined 86,163 state recertification surveys conducted at 15,055 facilities in the period January 1, 2009-March 31, 2015. We found that these strategies were associated with increases in citations for only one of two targeted deficiencies (unnecessary drug use) and only after the third strategy (revisions to the federal guidelines for the citations) was implemented. Each strategy was associated with a modest but significant reduction in antipsychotic prevalence in the general nursing home population. Initial reductions were greater in the ten states with the highest prevalence of antipsychotic use in nursing homes, compared to the ten states with the lowest prevalence. Use of other psychoactive medications, some of which are potential substitutes for antipsychotics, varied with each strategy and by state. Continuous monitoring and consistent enforcement are needed to ensure the continued decline in unnecessary use of antipsychotics and psychoactive medications in nursing homes.
美国医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）启动了三项策略（分别在 2012 年 3 月和 7 月，以及 2013 年 5 月），以减少疗养院中非必要抗精神病药物的使用，尤其是为了控制痴呆患者的行为症状而广泛使用这些药物。我们调查了 2009 年 1 月 1 日至 2015 年 3 月 31 日期间在 15055 个设施进行的 86163 次州重新认证调查。我们发现，这些策略仅与两个目标缺陷之一（不必要的药物使用）相关，而且仅在第三个策略（联邦准则修订以进行引用）实施后才会出现。每项策略都与一般疗养院人群中抗精神病药物的流行率适度但显著降低相关。在有最高抗精神病药物使用率的十个州，初始降幅大于在有最低抗精神病药物使用率的十个州。其他精神活性药物的使用（其中一些是抗精神病药物的潜在替代品）因每种策略和州而异。需要持续监测和一致执行，以确保疗养院中非必要使用抗精神病药物和精神活性药物的持续减少。
