Carnahan Ryan M, Brown Grant D, Letuchy Elena M, Rubenstein Linda M, Gryzlak Brian M, Smith Marianne, Reist Jeffrey C, Kelly Michael W, Schultz Susan K, Weckmann Michelle T, Chrischilles Elizabeth A
Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.
Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA.
Alzheimers Dement (N Y). 2017 Mar 6;3(4):553-561. doi: 10.1016/j.trci.2017.02.003. eCollection 2017 Nov.
Antipsychotics are used for managing behavioral and psychological symptoms of dementia (BPSD) but have risks. Anticholinergics can worsen outcomes in dementia. The Improving Antipsychotic Appropriateness in Dementia Patients educational program (IA-ADAPT) and Centers for Medicare and Medicaid Services Partnership to Improve Dementia Care (CMS Partnership) promote improved care for BPSD. The purpose of this study was to evaluate the impact of these programs on medication use and BPSD among nursing home residents.
This quasi-experimental longitudinal study used Medicare and assessment data for Iowa nursing home residents from April 2011 to December 2012. Residents were required to be eligible for six continuous months for inclusion. Antipsychotic use and anticholinergic use were evaluated on a monthly basis, and changes in BPSD were tracked using assessment data. Results are presented as odds ratios (ORs) per month after exposure to the IA-ADAPT or the start of the CMS Partnership.
Of 426 eligible Iowa nursing homes, 114 were exposed to the IA-ADAPT in 2012. Nursing home exposure to the IA-ADAPT was associated with reduced antipsychotic use (OR [95% CI] = 0.92 [0.89-0.95]) and anticholinergic use (OR [95% CI] = 0.95 [0.92-0.98]), reduced use of excessive antipsychotic doses per CMS guidance (OR [95% CI] = 0.80 [0.75-0.86]), increased odds of a potentially appropriate indication among antipsychotic users (OR [95% CI] = 1.04 [1.00-1.09]), and decreased documentation of verbal aggression (OR [95% CI] = 0.96 [0.94-0.99]). Facilities with two or more IA-ADAPT exposures had greater reductions in antipsychotic and anticholinergic use than those with only one. The CMS Partnership was associated with reduced antipsychotic use (OR [95% CI] = 0.96 [0.94-0.98]) and decreased documentation of any measured BPSD (OR [95% CI] = 0.98 [0.97-0.99]) as well as delirium specifically (OR [95% CI] = 0.98 [0.96-0.99]).
This study suggests that the IA-ADAPT and the CMS Partnership improved medication use with no adverse impact on BPSD.
抗精神病药物用于管理痴呆症的行为和心理症状（BPSD），但存在风险。抗胆碱能药物会使痴呆症的病情恶化。改善痴呆症患者抗精神病药物使用适宜性教育项目（IA - ADAPT）以及医疗保险和医疗补助服务中心改善痴呆症护理合作项目（CMS合作项目）促进了对BPSD的更好护理。本研究的目的是评估这些项目对疗养院居民药物使用和BPSD的影响。
这项准实验性纵向研究使用了2011年4月至2012年12月爱荷华州疗养院居民的医疗保险和评估数据。居民必须连续符合资格六个月才能纳入。每月评估抗精神病药物使用和抗胆碱能药物使用情况，并使用评估数据跟踪BPSD的变化。结果以暴露于IA - ADAPT或CMS合作项目启动后每月的优势比（OR）呈现。
在426家符合条件的爱荷华州疗养院中，2012年有114家接触了IA - ADAPT。疗养院接触IA - ADAPT与抗精神病药物使用减少（OR [95%置信区间] = 0.92 [0.89 - 0.95]）和抗胆碱能药物使用减少（OR [95%置信区间] = 0.95 [0.92 - 0.98]）、按照CMS指南减少过量抗精神病药物剂量的使用（OR [95%置信区间] = 0.80 [0.75 - 0.86]）、抗精神病药物使用者中潜在适宜指征的几率增加（OR [95%置信区间] = 1.04 [1.00 - 1.09]）以及言语攻击记录减少（OR [95%置信区间] = 0.96 [0.94 - 0.99]）相关。接触过两次或更多次IA - ADAPT的机构与仅接触过一次的机构相比，抗精神病药物和抗胆碱能药物使用的减少幅度更大。CMS合作项目与抗精神病药物使用减少（OR [95%置信区间] = 0.96 [0.94 - 0.98]）、任何测量的BPSD记录减少（OR [95%置信区间] = 0.98 [0.97 - 0.99]）以及谵妄记录减少（OR [95%置信区间] = 0.98 [0.96 -
