Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, Michigan, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA.
J Am Geriatr Soc. 2022 Dec;70(12):3513-3525. doi: 10.1111/jgs.18004. Epub 2022 Aug 19.
The Centers for Medicare & Medicaid Services implemented the National Partnership to Improve Dementia Care in Nursing Homes (the Partnership) to decrease antipsychotic use and improve care for nursing home (NH) residents with dementia. We determined whether the extent of antipsychotic and other psychotropic medication prescribing in AL residents with dementia mirrored that of long-stay NH (LSNH) residents after the Partnership.
Using a 20% sample of fee-for-service Medicare beneficiaries with Part D, we conducted a retrospective cohort study including AL and LSNH residents with dementia. The monthly prevalence of psychotropic medication prescribing (antipsychotics, antidepressants, anxiolytics/sedative-hypnotics, anticonvulsants/mood stabilizers, benzodiazepines, and antidementia medications) was examined. We used an interrupted time-series analysis to compare medication prescribing before (July 1, 2010-March 31, 2012) and after (April 1, 2012-December 31, 2017) the Partnership in both settings.
We identified 107,931 beneficiaries with ≥1 month as an AL resident and 323,766 beneficiaries with ≥1 month as a LSNH resident with dementia, including 1,923,867 person-months and 4,984,405 person-months, respectively. Antipsychotic prescribing declined over the study period in both settings. After the launch of the Partnership, the rate of decline in antipsychotic prescribing slowed in AL residents with dementia (slope change = 0.03 [95% CLs: 0.02, 0.04]) while the rate of decline in antipsychotic prescribing increased in LSNH residents with dementia (slope change = -0.12 [95% CLs: -0.16, -0.08]). Antidepressants were the most prevalent medication prescribed, anticonvulsant/mood stabilizer prescribing increased, and anxiolytic/sedative-hypnotic and antidementia medication prescribing declined.
The federal Partnership to reduce antipsychotic prescribing in NH residents did not appear to affect antipsychotic prescribing in AL residents with dementia. Given the increase in the prescribing of mood stabilizers/anticonvulsants that occurred after the launch of the Partnership, monitoring may be warranted for all psychotropic medications in AL and NH settings.
医疗保险和医疗补助服务中心实施了国家改善疗养院痴呆症护理伙伴关系（伙伴关系），以减少抗精神病药物的使用并改善痴呆症疗养院（NH）居民的护理。我们确定在伙伴关系之后，具有痴呆症的辅助生活（AL）居民的抗精神病药物和其他精神药物处方的程度是否与长期居住 NH（LSNH）居民的处方程度相符。
我们使用了 20%的有 Part D 的医疗保险付费受益人的样本，进行了一项包括具有痴呆症的 AL 和 LSNH 居民的回顾性队列研究。检查了精神药物处方的每月流行率（抗精神病药，抗抑郁药，抗焦虑药/镇静催眠药，抗惊厥药/情绪稳定剂，苯二氮卓类药物和抗痴呆药）。我们使用中断时间序列分析比较了在伙伴关系前后（2012 年 4 月 1 日至 2017 年 12 月 31 日）两个环境中的药物处方。
我们确定了 107931 名受益人为 AL 居民，至少有 1 个月，323766 名受益人为 LSNH 居民，至少有 1 个月患有痴呆症，分别包括 1923867 人月和 4984405 人月。在研究期间，两种情况下的抗精神病药物处方均呈下降趋势。在伙伴关系启动后，具有痴呆症的 AL 居民中抗精神病药物处方的下降速度减慢（斜率变化= 0.03 [95% CLs：0.02，0.04]），而 LSNH 居民中抗精神病药物处方的下降速度增加（斜率变化= -0.12 [95% CLs：-0.16，-0.08]）。抗抑郁药是最常开的药物，抗惊厥药/情绪稳定剂的处方增加，而抗焦虑药/镇静催眠药和抗痴呆药的处方减少。
联邦减少 NH 居民抗精神病药物处方的伙伴关系似乎并未影响具有痴呆症的 AL 居民的抗精神病药物处方。鉴于伙伴关系启动后抗惊厥药/情绪稳定剂的处方增加，可能需要在 AL 和 NH 环境中监测所有精神药物。
