Impact of programs to reduce antipsychotic and anticholinergic use in nursing homes.

Autor: Carnahan RM; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA., Brown GD; Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA., Letuchy EM; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA., Rubenstein LM; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA., Gryzlak BM; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA., Smith M; University of Iowa College of Nursing, Iowa City, IA, USA., Reist JC; Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA, USA., Kelly MW; Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA, USA., Schultz SK; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA.; James A. Haley Veterans Hospital, Mental Health and Behavioral Science Service, Tampa, FL, USA., Weckmann MT; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA, USA.; Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.; Department of Palliative Care, University of Iowa Carver College of Medicine, Iowa City, IA, USA., Chrischilles EA; Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA.
Jazyk: angličtina
Zdroj: Alzheimer's & dementia (New York, N. Y.) [Alzheimers Dement (N Y)] 2017 Mar 06; Vol. 3 (4), pp. 553-561. Date of Electronic Publication: 2017 Mar 06 (Print Publication: 2017).
DOI: 10.1016/j.trci.2017.02.003
Abstrakt: Introduction: Antipsychotics are used for managing behavioral and psychological symptoms of dementia (BPSD) but have risks. Anticholinergics can worsen outcomes in dementia. The Improving Antipsychotic Appropriateness in Dementia Patients educational program (IA-ADAPT) and Centers for Medicare and Medicaid Services Partnership to Improve Dementia Care (CMS Partnership) promote improved care for BPSD. The purpose of this study was to evaluate the impact of these programs on medication use and BPSD among nursing home residents.
Methods: This quasi-experimental longitudinal study used Medicare and assessment data for Iowa nursing home residents from April 2011 to December 2012. Residents were required to be eligible for six continuous months for inclusion. Antipsychotic use and anticholinergic use were evaluated on a monthly basis, and changes in BPSD were tracked using assessment data. Results are presented as odds ratios (ORs) per month after exposure to the IA-ADAPT or the start of the CMS Partnership.
Results: Of 426 eligible Iowa nursing homes, 114 were exposed to the IA-ADAPT in 2012. Nursing home exposure to the IA-ADAPT was associated with reduced antipsychotic use (OR [95% CI] = 0.92 [0.89-0.95]) and anticholinergic use (OR [95% CI] = 0.95 [0.92-0.98]), reduced use of excessive antipsychotic doses per CMS guidance (OR [95% CI] = 0.80 [0.75-0.86]), increased odds of a potentially appropriate indication among antipsychotic users (OR [95% CI] = 1.04 [1.00-1.09]), and decreased documentation of verbal aggression (OR [95% CI] = 0.96 [0.94-0.99]). Facilities with two or more IA-ADAPT exposures had greater reductions in antipsychotic and anticholinergic use than those with only one. The CMS Partnership was associated with reduced antipsychotic use (OR [95% CI] = 0.96 [0.94-0.98]) and decreased documentation of any measured BPSD (OR [95% CI] = 0.98 [0.97-0.99]) as well as delirium specifically (OR [95% CI] = 0.98 [0.96-0.99]).
Discussion: This study suggests that the IA-ADAPT and the CMS Partnership improved medication use with no adverse impact on BPSD.
Databáze: MEDLINE
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