Prescribing trends and associated outcomes of antiepileptic drugs and other psychoactive medications in US nursing homes surrounding the COVID-19 pandemic

COVID-19 大流行期间美国疗养院抗癫痫药物和其他精神活性药物的处方趋势和相关结果

• 批准号: 10446265
• 负责人: Jonathan David Winter
• 金额: $ 70.21万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10446265
• 关键词: Adverse event; Alzheimer' s Disease; Alzheimer' s disease care; Alzheimer' s disease related dementia; Antiepileptic Agents; Antipsychotic Agents; Attitude; Behavior; Behavioral Symptoms; Belief; Black race; COVID-19 pandemic; Caring; Cessation of life; Characteristics; Cognitive; Data; Data Set; Dementia; Diagnosis; Diagnostic; Drug Prescriptions; Drug usage; Elements; Emergency department visit; Epilepsy; Event; Goals; Health; Home Nursing Care; Hospital Records; Hospitalization; Individual; Knowledge; Label; Link; Measures; Medical; Methods; Monitor; Moods; National Institute on Aging; Nursing Homes; Outcome; Patients; Pattern; Pharmaceutical Preparations; Pilot Projects; Planning Theory; Policies; Population; Prevalence; Psychotropic Drugs; Research; Resources; Risk; Role; Safety; Sampling; Surveys; Symptoms; Vulnerable Populations; base; cohort; coronavirus disease; dementia care; falls; gender disparity; hospice environment; improved; innovation; neuropsychiatric symptom; palliative; pandemic disease; pandemic stress; patient oriented; pressure; psychological symptom; racial disparity; response; statistics; stressor; trend

Since the National Partnership to Improve Dementia Care debuted in 2012 with the goal to reduce antipsychotic use in individuals with Alzheimer’s disease and/or Alzheimer’s-related dementias (AD/ADRD), CMS has scrutinized almost all associated long-stay psychoactive prescribing. While the long-stay use of these monitored psychoactive drugs has declined, prescriptions of mood-stabilizing antiepileptic drugs (AEDs) have increased. Similar to antipsychotics, mood stabilizing AEDs are used to treat the behavioral and psychological symptoms of dementia (BPSD) in the AD/ADRD population. Unlike antipsychotics and other psychoactive medications, AEDs prescribed in nursing homes are not mandatorily reported to CMS. Pilot studies suggest AED increases are concentrated entirely in AD/ADRD and other dementia patients with no diagnosis of epilepsy and purposefully prescribed for BPSD as an unmonitored alternative to antipsychotics. AEDs are not approved to treat AD/ADRD or any dementia symptoms, have weak efficacy evidence, and convey serious risk. Increasingly, the Partnership’s debut seems an inflection point where the trend toward unmonitored alternative drugs for AD/ADRD symptoms sharply increased. Furthermore, initial findings hint that the COVID pandemic represents a second critical point of inflection where the existing transition toward non-superior but unreported drugs for AD/ADRD is again rapidly accelerating. All outcomes associated with this evolving pre-scribing phenomenon remain unknown, though early data warns that harms may be increasing without benefit. We propose a retrospective analysis detailing long-stay prescribing of all psychoactives, including AEDs, for AD/ADRD and other conditions, how such prescribing is changing under the combined pressures of the pandemic and targeted reduction efforts, and the role of such prescribing in adverse health outcomes. We will accomplish this by creating a detailed dataset of quarterly cohorts of nursing home residents, including those with AD/ADRD, for the years 2009-2021 that draws on elements linked at an individual level from CMS’s Minimum Data Set (MDS), Part D, MedPAR, and Public Use files. The final linked dataset will include health, demographic, cognitive, and diagnostic variables, all psychoactive drug claims, nursing home outcomes, records of hospital and ER adverse events, and long-stay facility details, including staffing resources and COVID statistics. Finally, to help explain and validate findings, a national sampling of nursing home prescribers will be surveyed regarding their knowledge and beliefs surrounding changing approaches to the care of AD/ ADRD and associated outcomes. This study will describe current and evolving AED use in nursing homes for all indications, focusing on AD/ADRD and AD/ADRD outcomes. It will describe racial and gender disparities in the long-stay populations treated or not treated with psychoactives. It will delineate the impact of the COVID pandemic in combination with national policies on ADRD management and outcomes. Results of this study will inform policymakers, improve nursing home care and safety, and introduce new avenues for ongoing research.

自从2012年首次促进痴呆症护理的全国合作伙伴关系以减少阿尔茨海默氏病和/或阿尔茨海默氏症相关的痴呆症（AD/ADRD）中的抗精神病药物的目标以来，CMS几乎仔细检查了几乎所有相关的长期精神活性处方。尽管这些受监测的精神活性药物的长期使用已经下降了，但刺激性抗癫痫药（AED）的处方已增加。与抗精神病药类似，情绪稳定AED用于治疗AD/ADRD人群中痴呆症（BPSD）的行为和心理症状。与抗精神病药和其他精神活性药物不同，护士房屋中规定的AED并未向CMS报告。试点研究表明，AED的增加完全集中在AD/ADRD和其他痴呆症患者中，没有癫痫病诊断，并有目的地为BPSD处方作为抗精神病药的意外选择。 AED不被批准用于治疗AD/ADRD或任何痴呆症症状，效率较弱并传达严重的风险。伙伴关系的首次亮相似乎是一个影响点，在使未知的AD/ADRD症状替代药物的趋势急剧增加。此外，初步发现暗示，互联的大流行是感染的第二个临界点，其中现有向非较高但未报告的AD/ADRD药物再次迅速加速了。与这种不断发展的预订现象相关的所有结果仍然未知，尽管早期的数据战可能会增加而没有利益。 我们将在2009 - 2021年中创建季度护士居民（包括AD/ADRD）的季度人群的详细数据集来实现这一目标，该数据集借鉴了CMS的最小数据集（MDS），D部分，MEDPAR和公共用途文件的单个级别链接的元素。最终链接的数据集将包括健康，人口统计，认知和诊断变量，所有精神活性药物索赔，护士家庭成果，医院和ER不良事件的记录以及长期设施的详细信息，包括人员配备资源和共同统计。最后，为了解释和验证调查结果，将对护士房屋处方者进行全国取样，以了解其知识和信念，围绕着不断变化的AD/ ADRD和相关成果的方法进行的知识和信念。这项研究将描述护士房屋中的当前和不断发展的AED用途，以关注AD/ADRD和ADRD结果。它将描述在经过心理活性治疗或未治疗的长期人群中的种族和性别分布。它将描述共同大流行对国家政策对ADRD管理和成果的影响。这项研究的结果将为决策者提供信息，改善护士家庭护理和安全，并引入新的途径进行正在进行的研究。