Wallem Alexandra, Martinez Ashley I, Vickers Lauren, Singleton Michael, Moga Daniela C
University of Kentucky College of Pharmacy, Lexington, KY, USA.
University of Maryland School of Pharmacy, Baltimore, MD, USA.
Explor Res Clin Soc Pharm. 2021 Aug 8;3:100058. doi: 10.1016/j.rcsop.2021.100058. eCollection 2021 Sep.
BACKGROUND: There is currently insufficient data describing how new medications are provided to older adult ambulatory patients with dementia in the United States (US). OBJECTIVES: To describe characteristics of ambulatory care visits for adults ≥65 years old and investigate differences in prescribing of new medications between patients with and without dementia. METHODS: We conducted a population-based cross-sectional study using the 2016 National Ambulatory Medical Care Survey (NAMCS) in the US. Non-perioperative ambulatory care visits of patients ≥65 years old with sampling weights were used to provide national estimates of visits. Baseline characteristics were compared between visits for patients with and without dementia using Pearson's chi square or Student's tests. We used multivariable logistic regression to estimate the odds of receiving a new medication. RESULTS: 218,182,131 non-perioperative ambulatory care visits of patients ≥65 years old were included, 2.1% of which were for patients with dementia; these patients were older on average and had more comorbidities and higher ambulatory care utilization than those without dementia. New medications were provided at 26.3% of visits for patients with dementia. After adjusting for confounders, there was no statistically significant difference in odds of a new medication being provided between visits for patients with and without dementia (odds ratio [OR], 0.555; 95% confidence interval [CI], 0.183-1.678). Differences were seen in the provision of cholinesterase inhibitors, antipsychotics, and central nervous system agents at visits for patients with dementia ( = 0.0011, <0.0001, and 0.0011 respectively). CONCLUSION: While fewer visits for patients with dementia provided new medications compared to patients without dementia, after adjusting for confounders no significant difference were identified. Significant differences were seen in the classes of new medications provided. Further investigation is needed to evaluate new medication usage and the utility of pharmacists in the care of patients with dementia at an outpatient setting.
背景：目前，在美国，关于如何为患有痴呆症的老年门诊患者提供新药的数据不足。 目的：描述65岁及以上成年人门诊护理就诊的特征，并调查患有和未患有痴呆症的患者在新药处方方面的差异。 方法：我们使用2016年美国国家门诊医疗护理调查（NAMCS）进行了一项基于人群的横断面研究。使用有抽样权重的65岁及以上患者的非围手术期门诊护理就诊数据来提供全国就诊估计值。使用Pearson卡方检验或学生检验比较患有和未患有痴呆症患者就诊的基线特征。我们使用多变量逻辑回归来估计接受新药的几率。 结果：纳入了218,182,131次65岁及以上患者的非围手术期门诊护理就诊，其中2.1%是针对患有痴呆症的患者；这些患者平均年龄更大，合并症更多，门诊护理利用率比未患有痴呆症的患者更高。痴呆症患者就诊中有26.3%提供了新药。在调整混杂因素后，患有和未患有痴呆症患者就诊时提供新药的几率没有统计学上的显著差异（优势比[OR]，0.555；95%置信区间[CI]，0.183 - 1.678）。在痴呆症患者就诊时，胆碱酯酶抑制剂、抗精神病药物和中枢神经系统药物的提供存在差异（分别为 = 0.0011、<0.0001和0.0011）。 结论：与未患有痴呆症的患者相比，患有痴呆症的患者获得新药的就诊次数较少，但在调整混杂因素后未发现显著差异。在提供的新药类别方面存在显著差异。需要进一步调查以评估门诊环境下新药的使用情况以及药剂师在痴呆症患者护理中的作用。
Explor Res Clin Soc Pharm. 2021-8-8
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