Department of Primary and Community Care,Radboud University Medical Centre,Nijmegen,The Netherlands.
Department of General Practice and Elderly Care Medicine and Amsterdam Public Health research institute,VU University Medical Center,Amsterdam,The Netherlands.
Int Psychogeriatr. 2018 Apr;30(4):547-556. doi: 10.1017/S1041610217001958. Epub 2017 Sep 21.
ABSTRACTBackground:We studied the patient and non-patients factors of inappropriate psychotropic drug (PD) prescription for neuropsychiatric symptoms (NPS) in nursing home patients with severe dementia.
In a cross-sectional study, the appropriateness of prescriptions was explored using the Appropriate Psychotropic drug use In Dementia (APID) index sum score. This index assesses information from medical records on indication, evaluation, dosage, drug-drug interactions, drug-disease interactions, duplications, and therapy duration. Various measurements were carried out to identify the possible patient and non-patient factors. Linear multilevel regression analysis was used to identify factors that are associated with APID index sum scores. Analyses were performed for groups of PDs separately, i.e. antipsychotics, antidepressants, anxiolytics, and hypnotics.
The sample consisted of 338 patients with a PD prescription that used 147 antipsychotics, 167 antidepressants, 85 anxiolytics, and 76 hypnotics. It was found that older patients and more severe aggression, agitation, apathy, and depression were associated with more appropriate prescriptions. Additionally, less appropriate prescriptions were found to be associated with more severe anxiety, dementia diagnoses other than Alzheimer dementia, more physician time available per patient, more patients per physician, more years of experience of the physician, and higher nurse's workload.
The association of more pronounced NPS with more appropriate PD prescriptions implies that physicians should pay more attention to the appropriateness of PD prescriptions when NPS are less manifest. Non-patient-related factors are also associated with the appropriateness of PD prescriptions. However, especially considering that some of these findings are counter-intuitive, more research on the topic is recommended.
本研究旨在探讨在患有严重痴呆的养老院患者中，精神科药物（PD）治疗神经精神症状（NPS）不合理处方的患者和非患者相关因素。
在一项横断面研究中，我们使用适当精神科药物在痴呆中的应用（APID）指数总分来评估处方的适当性。该指数评估了从病历中获取的信息，包括适应证、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。进行了各种测量以确定可能的患者和非患者因素。使用线性多层回归分析确定与 APID 指数总分相关的因素。分别对 PD 组（即抗精神病药、抗抑郁药、抗焦虑药和催眠药）进行分析。
该样本包括 338 名使用 147 种抗精神病药、167 种抗抑郁药、85 种抗焦虑药和 76 种催眠药的 PD 处方患者。结果发现，年龄较大、更严重的攻击、激越、淡漠和抑郁与更合理的处方相关。此外，更不合理的处方与更严重的焦虑、除阿尔茨海默病以外的痴呆诊断、每位患者的医生可利用时间更多、每位医生的患者更多、医生的经验年限更多以及护士的工作量更大相关。
更明显的 NPS 与更合理的 PD 处方之间的关联表明，当 NPS 表现不明显时，医生应更加关注 PD 处方的合理性。非患者相关因素也与 PD 处方的合理性相关。然而，特别是考虑到其中一些发现与直觉相悖，建议对该主题进行更多研究。
