Impact of COVID-19 on Continuity of Care for Veterans on Antipsychotic Medications

COVID-19 对退伍军人抗精神病药物护理连续性的影响

• 批准号: 10538353
• 负责人: ANOUK L GRUBAUGH
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-11-01 至 2024-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10538353
• 关键词: Address; Adherence; Administrator; Admission activity; Age; Age of Onset; Agranulocytosis; Antipsychotic Agents; Area; Attitude; Behavior; Bipolar Disorder; Blood Glucose; Blood Pressure; COVID-19; COVID-19 impact; Caring; Chronic; Chronic Disease; Clinical; Clozapine; Code; Continuity of Patient Care; Data; Data Sources; Diabetes Mellitus; Diagnostic; Disease; Drug Prescriptions; Emergency Care; Emergency Situation; Ethnic Origin; Event; Fasting; Future; Gender; Generations; Guidelines; Health; Health Personnel; Healthcare; Healthcare Systems; Heart; Heart Diseases; Individual; Inpatients; Interruption; Interview; Knowledge; Lipids; Malignant Neoplasms; Mental Health; Mental disorders; Metabolic; Methodology; Methods; Military Personnel; Monitor; Nurse Practitioners; Outcome; Outpatients; Patients; Pharmaceutical Preparations; Pharmacists; Population; Provider; Psychiatrist; Public Health; Race; Research Design; Resistance; Rural; Safety; Schizophrenia; Services; Statistical Methods; Suggestion; Suicide; Suicide prevention; System; Testing; Veterans; Visit; Weight; Woman; care outcomes; cohort; cost; economic impact; ethnic minority; experience; health care availability; health care delivery; health care service utilization; heart function; hospital readmission; insight; military veteran; mortality; multiple data sources; neutrophil; non-compliance; obesity risk; patient population; pharmacy benefit; post-COVID-19; prevent; racial minority; racial population; relapse prevention; rural area; severe mental illness; side effect; symptom management; urban dwelling

Background: Severe mental illnesses are consistently ranked as some of the most debilitating health conditions worldwide due to their early age of onset, chronicity, and impact on functioning. Fortunately, a number of antipsychotic medications have been found to be effective for managing the symptoms of severe mental illness (SMI) and for preventing relapse and rehospitalization. Despite their efficacy, treatment non-compliance for individuals on these medications is high due to a number of factors including poor insight into illness, negative attitudes about medication, and medication related side effects. Further complicating care and outcomes for this clinical population, providers must maintain close oversight of patients on antipsychotics due to the impact of these medications on metabolic and cardiac functioning which confer an increased risk of obesity, diabetes, heart problems, and other chronic illnesses. This oversight includes regular monitoring of weight, blood pressure, fasting blood glucose, and lipid levels. Additionally, clozapine, indicated for treatment-resistant schizophrenia, requires weekly-to-monthly monitoring of absolute neutrophil counts to prevent potentially fatal clozapine- induced agranulocytosis. Significance: The proposed project has significant and immediate relevance to Veterans and the VHA in that it seeks to better understand if and to what extent COVID-19 related care disruptions impacted care and outcomes for Veterans with SMI prescribed antipsychotic medications. Given pre- existing challenges in the treatment of this Veteran population, this is an important area of inquiry as well as one for which little is known. Added strengths of the proposed study include the use of a mixed methods approach that includes national level data from multiple sources. Aside from addressing a critical knowledge gap, the proposed study targets what is unarguably one of the most vulnerable patient populations within the VA and other healthcare systems—patients with SMI prescribed antipsychotic medications. Specific Aims: Aim 1: To assess the impact of COVID-19 related care disruptions on healthcare use and outcomes for Veterans on antipsychotic medications using robust statistical methods and national level data; Aim 2: To assess whether the impact of COVID-19 related care disruptions differ by race/ethnicity, gender, age, and rural/urban status using national level data; Aim 3: To conduct thematic interviews with provider and patient stakeholder groups at the national level to better understand COVID-19 related care disruptions. Provider stakeholders (e.g., psychiatrists, advanced nurse practitioners) will be interviewed to better understand COVID-19 related changes in practice behaviors, the perceived impact of these changes on care continuity and outcomes, and to solicit suggestions to mitigate the impact of interrupted care in the future; Veterans prescribed antipsychotic medication prescriptions in the pre COVID-19 window will be interviewed to better understand the impact of COVID-19 related care disruptions on treatment seeking behaviors, obstacles encountered with regard to access, and to explore other factors potentially impacting outcomes in this patient group. Methodology: The proposed study will employ a mixed-methods (quantitative/qualitative) approach. For Aims 1 & 2 we will employ retrospective, observational analyses using a national cohort of Veterans (N>250,000) with an ICD-CM-10 diagnostic code for schizophrenia or bipolar disorder prescribed a first-generation or second-generation antipsychotic [1/19-12/21]. Veterans of all ages, genders, racial groups, military eras will be included in the cohort. Aim 3 will involve individual thematic interviews with provider (n=35-45) and patient stakeholders (n=50-60). Next Steps/Implementation: Findings from this 2-year project will be of immediate relevance and impact for local, regional, and national level administrators and mental health providers as well as the VA Office of Mental Health and Suicide Prevention and VA Pharmacy Benefits Management Services. Collectively, data from this project will serve to identify potential strategies to further mitigate the impact of COVID-19 on the care and outcomes of Veterans with SMI as well as prepare for future public health and/or other national emergencies.

背景：严重的精神疾病始终被评为最令人衰弱的健康状况 全球由于其发病，慢性和对功能的影响。幸运的是，许多 已经发现抗精神病药可有效地管理严重精神疾病的症状 （SMI），并防止救济和复苏。尽管有效率，但治疗不合规 由于许多因素，包括对疾病的洞察力不佳，负面的因素，这些药物的个人很高 对药物和药物相关的副作用的态度。进一步使护理和结果复杂化 临床人群，提供者必须对患者进行抗精神病药的严格监督，因为 这些有关代谢和心脏功能的药物，会议增加肥胖，糖尿病的风险 心脏病和其他慢性病。此监督包括定期监测体重，血压， 空腹血糖和脂质水平。此外，氯氮平，用于耐治疗的精神分裂症， 需要每周至月度监测绝对中性粒细胞计数，以防止潜在的致命氯氮平 - 诱导的粒细胞增多症。意义：拟议的项目与 退伍军人和VHA旨在更好地理解Covid-19相关护理是否以及在何种程度上 干扰对使用SMI处方抗精神病药的退伍军人的护理和结果。给出 现有的挑战在治疗这位资深人口中，这是一个重要的询问领域，也是一个重要领域 对于哪几却是众所周知的。拟议研究的增加的优势包括使用混合方法方法 其中包括来自多个来源的国家一级数据。除了解决关键知识差距外， 拟议的研究针对的是，毫无疑问是VA中最脆弱的患者人群之一 其他医疗保健系统 - 患有SMI处方抗精神病药的患者。具体目的：目标1： 评估COVID-19相关护理中断对退伍军人的医疗保健使用和结果的影响 使用强大的统计方法和国家一级数据的抗精神病药物；目标2：评估是否 COVID-19相关护理中断的影响因种族/种族，性别，年龄和粗糙/城市状况而不同 国家一级数据； AIM 3：与提供者和患者利益相关者群体进行主题访谈 更好地了解Covid-19相关护理中断的国家一级。提供者利益相关者（例如，精神科医生， 高级护士从业者）将接受采访，以更好地了解Covid-19 行为，这些变化对护理连续性和结果的影响，并征求建议 减轻未来中断护理的影响；退伍军人处方的抗精神病药物 COVID-19窗口前的处方将接受采访，以更好地了解Covid-19的影响 有关治疗行为的相关护理中断，访问遇到的障碍以及 探索其他可能影响该患者组结果的因素。方法论：拟议的研究 将采用混合方法（定量/定性）方法。对于目标1和2，我们将采用回顾性， 使用全国退伍军人队列（N> 250,000）与ICD-CM-10诊断代码进行观察分析 精神分裂症或躁郁症规定了第一代或第二代抗精神病药[1/19-12/21]。 各个年龄段的退伍军人，性别，种族团体，军事时代将包括在该队列中。 AIM 3将涉及 提供者（n = 35-45）和患者利益相关者（n = 50-60）的个人主题访谈。下一个 步骤/实施：这个为期两年项目的调查结果将对当地人有直接的相关性和影响 地区，国家一级管理员和心理健康提供者以及VA心理健康办公室 预防自杀和VA药房福利管理服务。总的来说，该项目的数据 将有助于确定潜在的策略，以进一步减轻Covid-19的影响 拥有SMI的退伍军人，并为未来的公共卫生和/或其他国家紧急情况做准备。