Penn Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
J Am Med Dir Assoc. 2022 Nov;23(11):1780-1786.e2. doi: 10.1016/j.jamda.2022.05.025. Epub 2022 Jun 27.
We examined the association between nursing home (NH) characteristics and whether NHs had high or low levels of antipsychotic, benzodiazepine, or opioid prescribing to residents with Alzheimer's disease and related dementias (ADRD). We then measured the likelihood that NHs who were high (low) prescribers of antipsychotics were also high (low) prescribers of benzodiazepines or opioids.
A retrospective, cross-sectional analysis.
The sample included 448,128 Medicare beneficiaries diagnosed with ADRD, who resided in 13,151 NHs in 2017.
Using Medicare claims, the Minimum Data Set, and LTCFocus, we measured the share of NH residents with ADRD who filled ≥1 antipsychotic, benzodiazepine, or opioid prescription in 2017. Using linear probability models with state-clustered SEs, we identified which NH characteristics were associated with being in the top (bottom) quartile of the prescribing distribution for each drug class. Finally, we measured whether NHs who were top-quartile (bottom-quartile) antipsychotic prescribers were more likely to be top-quartile (bottom-quartile) benzodiazepine or opioid prescribers.
Across NHs, an average of 29.1% of residents with ADRD received an antipsychotic, 30.2% received a benzodiazepine, and 40.9% received an opioid. Smaller NHs and NHs with a larger share of Medicaid-enrolled residents were more likely to be top-quartile prescribers; NHs with more registered nursing care were more likely to be bottom-quartile prescribers. Antipsychotic prescribing tracked closely with benzodiazepine prescribing, but not opioid prescribing.
The overlap between antipsychotic and benzodiazepine prescribing and our finding that some NH characteristics were consistently associated with prescribing across drug classes may support the idea of an organizational culture of prescribing in NHs, which could inform efforts to improve prescribing quality in NHs. Our results also highlight benzodiazepine and opioid use for ADRD, which were more commonly prescribed than antipsychotics in NHs but have received less regulatory attention.
我们研究了养老院（NH）的特征与 NH 是否为患有阿尔茨海默病和相关痴呆症（ADRD）的居民开出高或低水平的抗精神病药、苯二氮䓬类或阿片类药物之间的关联。然后，我们测量了那些开出高（低）剂量抗精神病药的 NH 也开出高（低）剂量苯二氮䓬类或阿片类药物的可能性。
回顾性、横断面分析。
样本包括 2017 年在 13151 家 NH 居住的 448128 名 Medicare 受益人与 ADRD 诊断相关的居民。
使用 Medicare 索赔、最低数据集和 LTCFocus，我们测量了 2017 年有 ADRD 的 NH 居民中每一种药物类别的≥1 种抗精神病药、苯二氮䓬类或阿片类药物处方的比例。使用带有州聚类 SE 的线性概率模型，我们确定了哪些 NH 特征与每种药物类别的处方分布的前（后）四分位数相关。最后，我们测量了那些处于抗精神病药处方前（后）四分位数的 NH 是否更有可能成为苯二氮䓬类或阿片类药物处方的前（后）四分位数。
在 NH 中，平均有 29.1%的 ADRD 居民接受了抗精神病药治疗，30.2%的居民接受了苯二氮䓬类药物治疗，40.9%的居民接受了阿片类药物治疗。较小的 NH 和 Medicaid 参保居民比例较高的 NH 更有可能成为前四分位数的处方者；注册护理服务较多的 NH 更有可能成为后四分位数的处方者。抗精神病药的处方与苯二氮䓬类药物的处方密切相关，但与阿片类药物的处方无关。
抗精神病药和苯二氮䓬类药物处方的重叠，以及我们发现一些 NH 特征在不同药物类别中始终与处方相关，这可能支持 NH 中存在处方组织文化的观点，这可以为改善 NH 中的处方质量提供信息。我们的结果还突出了阿片类药物和苯二氮䓬类药物在 ADRD 中的使用，在 NH 中比抗精神病药更常用，但受到的监管关注较少。
