Impact of programs to reduce antipsychotic and anticholinergic use in nursing homes
| Autor: | Marianne Smith, Susan K. Schultz, Michael W. Kelly, Elena M. Letuchy, Linda M. Rubenstein, Grant D. Brown, Elizabeth A. Chrischilles, Michelle T. Weckmann, Ryan M. Carnahan, Brian M. Gryzlak, Jeffrey C. Reist |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Longitudinal study medicine.drug_class medicine.medical_treatment Education 03 medical and health sciences 0302 clinical medicine Intervention (counseling) medicine Anticholinergic Antipsychotics Dementia 030212 general & internal medicine Antipsychotic Psychiatry Nursing home business.industry Odds ratio Featured Article medicine.disease 3. Good health Psychiatry and Mental health Delirium Neurology (clinical) medicine.symptom business Medicaid Anticholinergics 030217 neurology & neurosurgery |
| Zdroj: | Alzheimer's & Dementia : Translational Research & Clinical Interventions |
| ISSN: | 2352-8737 |
| DOI: | 10.1016/j.trci.2017.02.003 |
| Popis: | 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. Highlights • IA-ADAPT is a training program with decision aids to improve dementia care. • The CMS Partnership is a national initiative with similar goals. • IA-ADAPT training was associated with reduced antipsychotic and anticholinergic use. • The CMS Partnership was associated with reduced antipsychotic use. • No adverse effects on behavioral or psychological symptoms were detected. |
| Databáze: | OpenAIRE |
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