Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA.
The Cecil G. Sheps Center for Health Services Research; School of Social Work; University of North Carolina at Chapel Hill, NC, USA.
J Am Med Dir Assoc. 2021 Sep;22(9):1813-1818.e3. doi: 10.1016/j.jamda.2020.11.037. Epub 2020 Dec 29.
In nursing homes (NHs), psychoactive medication use has received notable attention, but less is known about prescribing in assisted living (AL). This study examined how antipsychotic and antianxiety medication prescribing in AL compares with NHs.
Observational, cross-sectional AL data linked to publicly reported NH measures.
Random sample of 250 AL communities and the full sample of 3371 NHs in 7 states.
We calculated the percentage of residents receiving antipsychotics and antianxiety medications. For each AL community, we calculated the distance to NHs in the state. Linear models estimated the relationship between AL prescribing and that of the closest and farthest 5 NHs, adjusting for AL characteristics and state fixed effects.
The prescribing rate of potentially inappropriate antipsychotics (i.e., excluding for persons with recorded schizophrenia and Tourette syndrome) and of antianxiety medications (excluding for those on hospice) in AL was 15% and 21%, respectively. Unadjusted mean antipsychotic prescribing rates were nominally higher in AL than NHs (14.8% vs 14.6%; P = .056), whereas mean antianxiety prescribing was nominally lower in AL (21.2% vs 22.6%; P = .032). In adjusted analyses, AL rates of antipsychotic use were not associated with NH rates. However, being affiliated with an NH was associated with a lower rate of antipsychotic use [b = -0.03; 95% confidence interval (CI) -0.50 to -0.001; P = .043], whereas antianxiety rates were associated with neighboring NHs' prescribing rates (b = 0.43; 95% CI 0.16-0.70; P = .002).
This study suggests reducing antipsychotic medication use in NHs may influence AL practices in a way not accounted for by local NH patterns. And, because antianxiety medications have not been the focus of national campaigns, they may be more subject to local prescribing behaviors. It seems advantageous to consider prescribing in AL when efforts are implemented to change NH prescribing, as there seems to be related influence whether by affiliation or region.
在养老院（NH）中，精神活性药物的使用受到了广泛关注，但在辅助生活（AL）中，关于药物处方的研究则相对较少。本研究旨在比较 AL 中抗精神病药和抗焦虑药的使用情况与 NH 中的使用情况。
观察性、横断面 AL 数据与公开报告的 NH 措施相联系。
来自 7 个州的 250 个 AL 社区的随机样本和 3371 个 NH 样本。
我们计算了接受抗精神病药和抗焦虑药治疗的居民的百分比。对于每个 AL 社区，我们计算了该州 NH 的距离。线性模型估计了 AL 处方与距离最近和最远的 5 家 NH 之间的关系，调整了 AL 特征和州固定效应。
AL 中潜在不适当的抗精神病药（即不包括记录有精神分裂症和图雷特综合征的患者）和抗焦虑药物（不包括接受临终关怀的患者）的处方率分别为 15%和 21%。未经调整的平均抗精神病药处方率在 AL 中略高于 NH（14.8%比 14.6%；P=0.056），而 AL 中的平均抗焦虑药处方率略低（21.2%比 22.6%；P=0.032）。在调整后的分析中，AL 抗精神病药使用率与 NH 无关。然而，与 NH 相关联与较低的抗精神病药使用率相关（b=-0.03；95%置信区间[CI]：-0.50 至-0.001；P=0.043），而抗焦虑药的使用率与附近 NH 的处方率相关（b=0.43；95%CI：0.16-0.70；P=0.002）。
本研究表明，减少 NH 中抗精神病药物的使用可能会以未被当地 NH 模式所解释的方式影响 AL 的实践。而且，由于抗焦虑药物不是全国性运动的重点，因此它们可能更容易受到当地处方行为的影响。似乎在实施改变 NH 处方的措施时，考虑 AL 的处方是有利的，因为无论通过关联还是地区，似乎都有相关的影响。
