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：严重的精神疾病一直被列为最使人衰弱的健康状况之一 幸运的是，由于其发病年龄早、长期性和对功能的影响，在世界范围内有许多此类疾病。 抗精神病药物已被发现可有效控制严重精神疾病的症状 (SMI) 以及预防复发和再住院，尽管它们有效，但治疗依从性不佳。 由于多种因素，包括对疾病的了解不足、负面影响等，个人服用这些药物的比例很高 对药物的态度以及药物相关的副作用使护理和结果进一步复杂化。 临床人群中，由于抗精神病药物的影响，医疗服务提供者必须对患者进行密切监督。 这些影响代谢和心脏功能的药物会增加肥胖、糖尿病、 心脏问题和其他慢性疾病，这包括定期监测体重、血压、 空腹血糖和血脂水平，氯氮平，适用于治疗难治性精神分裂症， 需要每周到每月监测中性粒细胞绝对计数，以防止潜在致命的氯氮平- 意义：所提议的项目与以下疾病具有重大且直接的相关性。 退伍军人和 VHA 旨在更好地了解是否以及在何种程度上提供与 COVID-19 相关的护理 干扰影响了接受 SMI 处方抗精神病药物治疗的退伍军人的护理和结果。 治疗退伍军人群体中存在的挑战，这是一个重要的调查领域，也是一个问题 拟议研究的额外优势包括使用混合方法。 除了解决关键的知识差距外，还包括来自多个来源的国家级数据。 拟议的研究针对的是 VA 内毫无疑问最脆弱的患者群体之一， 其他医疗保健系统——SMI 患者服用抗精神病药物： 目标 1： 评估与 COVID-19 相关的护理中断对退伍军人的医疗保健使用和结果的影响 使用可靠的统计方法和国家级数据来评估抗精神病药物是否 COVID-19 相关护理中断的影响因种族/民族、性别、年龄和农村/城市状况而异，使用 国家级数据；目标 3：对医疗机构的提供者和患者利益相关者群体进行专题访谈 国家层面更好地了解与 COVID-19 相关的护理中断（例如情绪、 高级执业护士）将接受采访，以更好地了解与 COVID-19 相关的实践变化 行为、这些变化对护理连续性和结果的感知影响，并征求建议 减轻未来护理中断的影响； 我们将对 COVID-19 之前窗口期的处方进行访谈，以更好地了解 COVID-19 的影响 寻求治疗行为方面的相关护理中断、在获得治疗方面遇到的障碍以及 探索可能影响该患者组结果的其他因素 方法：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，我们将采用回顾性方法。 使用具有 ICD-CM-10 诊断代码的全国退伍军人队列 (N>250,000) 进行观察分析 精神分裂症或躁郁症患者服用第一代或第二代抗精神病药物 [1/19-12/21]。 所有年龄、性别、种族、军事时代的退伍军人都将包括在目标 3 中。 与提供者 (n=35-45) 和患者利益相关者 (n=50-60) 进行个人专题访谈。 步骤/实施：这个为期 2 年的项目的调查结果将对当地、 地区和国家级管理人员和心理健康提供者以及退伍军人管理局心理健康办公室 自杀预防和 VA 药房福利管理服务 统称为该项目的数据。 将有助于确定进一步减轻 COVID-19 对护理和结果的影响的潜在策略 患有 SMI 的退伍军人以及为未来的公共卫生和/或其他国家紧急情况做好准备。