Shenandoah Family Practice Residency, Deparment of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA.
Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA.
Clin Gerontol. 2022 Oct-Dec;45(5):1180-1188. doi: 10.1080/07317115.2022.2063777. Epub 2022 Apr 21.
Compare Virginia nursing homes in the top- and bottom-quintiles of antipsychotic use for variation in community, social, and facility factors.
2018 CMS data ascertained Virginia nursing homes in the top and bottom quintiles for antipsychotic use. The Virginia Health Department provided social determinant of health (SDOH) statistics for each facility's county/city while claims identified facility demographics. Chi square and independent two-sample -tests compared quintiles for regional, social, and demographic differences.
Quintiles averaged 3000 residents and 56 facilities. Facilities with the lowest rates of antipsychotic use were more likely to be privately owned and had fewer African-American and minority residents and more white residents. All 18 SDOH statistics were superior for the communities of facilities with the lowest antipsychotic rates. Nine of these differences were statistically significant, including the aggregated "Health Opportunity Index."
The antipsychotic prevalence rate for facilities in the top-quintile of antipsychotic use is fivefold the bottom-quintile's rate. Antipsychotic prescribing in nursing homes is associated with regional, demographic, and social factors not addressed by existing antipsychotic reduction measures, with vulnerable populations at greatest risk.
The efficacy of measures aimed at curbing long-stay antipsychotic prescribing could be improved by addressing SDOH including economic opportunities.
比较弗吉尼亚州养老院中使用抗精神病药物最多和最少的五分之一的社区、社会和设施因素的差异。
2018 年 CMS 数据确定了弗吉尼亚州养老院中使用抗精神病药物最多和最少的五分之一。弗吉尼亚州卫生部为每个设施所在的县/市提供了健康决定因素（SDOH）统计数据，而索赔则确定了设施的人口统计数据。卡方检验和独立两样本检验比较了五分之一的区域、社会和人口统计学差异。
五分之一的平均居民人数为 3000 人，设施数量为 56 个。使用抗精神病药物最低的设施更有可能是私人拥有的，拥有较少的非裔美国人和少数民族居民，以及更多的白人居民。所有 18 项 SDOH 统计数据都优于使用最低抗精神病药物率的设施的社区。其中 9 项差异具有统计学意义，包括综合的“健康机会指数”。
使用抗精神病药物最多的五分之一设施的抗精神病药物患病率是使用抗精神病药物最少的五分之一设施的五倍。养老院中抗精神病药物的处方与现有的抗精神病药物减少措施未解决的区域、人口统计学和社会因素有关，风险最大的是弱势群体。
通过解决 SDOH 包括经济机会，可能会提高旨在遏制长期使用抗精神病药物处方的措施的疗效。
