Department of Population and Quantitative Health Sciences, Division of Epidemiology, University of Massachusetts Chan Medical School, Worcester, MA.
Department of Population and Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Chan Medical School, Worcester, MA.
Med Care. 2024 Aug 1;62(8):511-520. doi: 10.1097/MLR.0000000000002016. Epub 2024 May 29.
Several antidementia medications have been approved for symptomatic treatment of cognitive and functional impairment due to Alzheimer disease. Antipsychotics are often prescribed off-label for behavioral symptoms.
The aim of this study was to describe the basis for regional variation in antidementia and antipsychotic medication use.
US nursing homes (n=9735), hospital referral regions (HRR; n=289).
Long-stay residents with dementia (n=273,004).
Using 2018 Minimum Data Set 3.0 linked to Medicare data, facility information, and Dartmouth Atlas files, we calculated prevalence of use and separate multilevel logistic models [outcomes: memantine, cholinesterase inhibitor (ChEI), antipsychotic use] estimated adjusted odds ratios (aOR) and 95% CIs for resident, facility, and HRR characteristics. We then fit a series of cross-classified multilevel logistic models to estimate the proportional change in cluster variance (PCV).
Overall, 20.9% used antipsychotics, 16.1% used memantine, and 23.3% used ChEIs. For antipsychotics, facility factors [eg, use of physical restraints (aOR: 1.08; 95% CI: 1.05-1.11) or poor staffing ratings (aOR: 1.10; 95% CI: 1.06-1.14)] were associated with more antipsychotic use. Nursing homes in HRRs with the highest health care utilization had greater antidementia drug use (aOR memantine: 1.68; 95% CI: 1.44-1.96). Resident/facility factors accounted for much regional variation in antipsychotics (PCV STATE : 27.80%; PCV HRR : 39.54%). For antidementia medications, HRR-level factors accounted for most regional variation (memantine PCV STATE : 37.44%; ChEI PCV STATE : 39.02%).
Regional variations exist in antipsychotic and antidementia medication use among nursing home residents with dementia suggesting the need for evidence-based protocols to guide the use of these medications.
已有几种抗痴呆药物被批准用于治疗阿尔茨海默病导致的认知和功能障碍的症状。抗精神病药常被超适应证用于治疗行为症状。
本研究旨在描述抗痴呆和抗精神病药物使用的区域差异的基础。
美国养老院（n=9735）、医院转诊区（HRR；n=289）。
患有痴呆症的长期居住者（n=273004）。
使用 2018 年 3.0 版最低数据集，结合医疗保险数据、机构信息和达特茅斯图集文件，我们计算了使用的患病率和单独的多层次逻辑模型[结局：美金刚、胆碱酯酶抑制剂（ChEI）、抗精神病药物使用]，估计调整后的比值比（aOR）和 95%置信区间（CI）居民、机构和 HRR 特征。然后，我们拟合了一系列交叉分类多水平逻辑模型，以估计聚类方差的比例变化（PCV）。
总体而言，20.9%使用抗精神病药，16.1%使用美金刚，23.3%使用 ChEI。对于抗精神病药，机构因素[例如，使用身体约束（aOR：1.08；95%CI：1.05-1.11）或较差的人员配备评级（aOR：1.10；95%CI：1.06-1.14）]与更多的抗精神病药使用相关。在医疗保健利用率最高的 HRR 中的养老院使用更多的抗痴呆药物（aOR 美金刚：1.68；95%CI：1.44-1.96）。居民/机构因素解释了抗精神病药使用的大部分区域差异（PCV STATE：27.80%；PCV HRR：39.54%）。对于抗痴呆药物，HRR 水平因素解释了大多数区域差异（美金刚 PCV STATE：37.44%；ChEI PCV STATE：39.02%）。
在患有痴呆症的养老院居民中，抗精神病药和抗痴呆药物的使用存在区域差异，这表明需要基于证据的方案来指导这些药物的使用。
