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Factors associated with drug prescribing practices in long-term care patients with cognitive impairment.

ABSTRACT: PURPOSE:To examine factors associated with prescribing anti-dementia medicines (ADM), atypical antipsychotics (A-APM), typical antipsychotics (T-APM), anxiolytics and other psychostimulants (OP) in the residents of long-term care institutions (LTCIs). METHODS:A cross-sectional survey of a country-representative sample of randomly selected LTCIs in Poland, conducted in 2015-2016. First, we identified 1035 residents with cognitive impairment (CI) among all 1587 residents. Next, we randomly selected 20 residents from each institution. Study sample consists of 455 residents with CI: 214 recruited from 11 nursing homes and 241 from 12 residential homes. We used InterRAI-LTCF questionnaire and drug dispensary cards administered on the day of data collection to assess use of drugs. Multiple correspondence analysis (MCA), descriptive and logistic regression analyses were performed. RESULTS:The residents were treated with ADM (13.4%), OP (14.3%), antipsychotics (46.4%) including A-APM (24.2%) and T-APM (27.9%), and anxiolytics (28.4%). Hydroxyzine was used most often among anxiolytics (71.3%). Prescribing of ADM was more likely in Alzheimer's disease (OR?=?4.378; 95%CI 2.173-8.823), while OP in other dementia (OR?=?1.873; 95%CI 1.007-3.485). Administration of A-APM was more likely in older residents (OR?=?1.032, 95%CI 1.009-1.055), and when delusions appeared (OR?=?2.082; 95%CI 1.199-3.613), while there were no neuropsychiatric factors increasing the odds of T-APM use. Prescribing of anxiolytics was less likely in moderate CI (by 47.2%) than in residents with mild CI. CONCLUSION:Current practices of prescribing psychotropics are inadequate in Polish LTCIs, especially in terms of use of T-APM and hydroxyzine. More attention should be given to motivate physicians to change their prescribing practices.

SUBMITTER: Kijowska V

PROVIDER: S-EPMC7550298 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Factors associated with drug prescribing practices in long-term care patients with cognitive impairment.

Kijowska Violetta V Barańska Ilona I Szczerbińska Katarzyna K

European geriatric medicine 20200525 5

<h4>Purpose</h4>To examine factors associated with prescribing anti-dementia medicines (ADM), atypical antipsychotics (A-APM), typical antipsychotics (T-APM), anxiolytics and other psychostimulants (OP) in the residents of long-term care institutions (LTCIs).<h4>Methods</h4>A cross-sectional survey of a country-representative sample of randomly selected LTCIs in Poland, conducted in 2015-2016. First, we identified 1035 residents with cognitive impairment (CI) among all 1587 residents. Next, we r ...[more]

PMID: 32451771

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Project description:BackgroundInsight into factors that influence antibiotic prescribing is crucial when developing interventions aimed at a more rational use of antibiotics. We examined factors that influence antibiotic prescribing in long-term care facilities, and present a conceptual model that integrates these factors.MethodsSemi-structured qualitative interviews were conducted with physicians (n?=?13) and nursing staff (n?=?13) in five nursing homes and two residential care homes in the central-west region of the Netherlands. An iterative analysis was applied to interviews with physicians to identify and categorize factors that influence antibiotic prescribing, and to integrate these into a conceptual model. This conceptual model was triangulated with the perspectives of nursing staff.ResultsThe analysis resulted in the identification of six categories of factors that can influence the antibiotic prescribing decision: the clinical situation, advance care plans, utilization of diagnostic resources, physicians' perceived risks, influence of others, and influence of the environment. Each category comprises several factors that may influence the decision to prescribe or not prescribe antibiotics directly (e.g. pressure of patients' family leading to antibiotic prescribing) or indirectly via influence on other factors (e.g. unfamiliarity with patients resulting in a higher physician perceived risk of non-treatment, in turn resulting in a higher tendency to prescribe antibiotics).ConclusionsOur interview study shows that several non-rational factors may affect antibiotic prescribing decision making in long-term care facilities, suggesting opportunities to reduce inappropriate antibiotic use. We developed a conceptual model that integrates the identified categories of influencing factors and shows the relationships between those categories. This model may be used as a practical tool in long-term care facilities to identify local factors potentially leading to inappropriate prescribing, and to subsequently intervene at the level of those factors to promote appropriate antibiotic prescribing.

Project description:Survivors of critical illness often have a prolonged and disabling form of cognitive impairment that remains inadequately characterized.We enrolled adults with respiratory failure or shock in the medical or surgical intensive care unit (ICU), evaluated them for in-hospital delirium, and assessed global cognition and executive function 3 and 12 months after discharge with the use of the Repeatable Battery for the Assessment of Neuropsychological Status (population age-adjusted mean [±SD] score, 100±15, with lower values indicating worse global cognition) and the Trail Making Test, Part B (population age-, sex-, and education-adjusted mean score, 50±10, with lower scores indicating worse executive function). Associations of the duration of delirium and the use of sedative or analgesic agents with the outcomes were assessed with the use of linear regression, with adjustment for potential confounders.Of the 821 patients enrolled, 6% had cognitive impairment at baseline, and delirium developed in 74% during the hospital stay. At 3 months, 40% of the patients had global cognition scores that were 1.5 SD below the population means (similar to scores for patients with moderate traumatic brain injury), and 26% had scores 2 SD below the population means (similar to scores for patients with mild Alzheimer's disease). Deficits occurred in both older and younger patients and persisted, with 34% and 24% of all patients with assessments at 12 months that were similar to scores for patients with moderate traumatic brain injury and scores for patients with mild Alzheimer's disease, respectively. A longer duration of delirium was independently associated with worse global cognition at 3 and 12 months (P=0.001 and P=0.04, respectively) and worse executive function at 3 and 12 months (P=0.004 and P=0.007, respectively). Use of sedative or analgesic medications was not consistently associated with cognitive impairment at 3 and 12 months.Patients in medical and surgical ICUs are at high risk for long-term cognitive impairment. A longer duration of delirium in the hospital was associated with worse global cognition and executive function scores at 3 and 12 months. (Funded by the National Institutes of Health and others; BRAIN-ICU ClinicalTrials.gov number, NCT00392795.).

Project description:ImportanceThe Centers for Medicare & Medicaid Services' (CMS) National Partnership to Improve Dementia Care in Nursing Homes ("CMS National Partnership") focuses on reducing antipsychotic prescribing to long-term care residents. Hospice enrollment is not an exclusionary condition for the antipsychotic quality measure reported by CMS. It is unclear how prescribing in hospice may have been impacted by the initiative.ObjectiveEstimate the association of the CMS National Partnership with trends in antipsychotic prescribing among long-term care residents in hospice.DesignInterrupted time-series analysis of a 100% Minimum Data Set sample with linked hospice claims from 2011 to 2017.SettingLong-term care nursing facilities.ParticipantsOlder adults ≥65 residing in long-term care (n = 3,741,379) and limited to those enrolled in hospice (n = 821,610).Main outcomeQuarterly prevalence of antipsychotic and other psychotropic (antianxiety, hypnotic, antidepressant) use among long-term care residents; overall and among residents with dementia, stratified by hospice enrollment.ResultsFrom 2011 to 2017, parallel declines in antipsychotic prescribing were observed among long-term care residents enrolled and not enrolled in hospice (hospice: decline from 26.8% to 18.7%; non-hospice: decline from 23.0% to 14.4%). Following the 2012 CMS National Partnership, quarterly rates of antipsychotic prescribing declined significantly for both residents enrolled and not enrolled in hospice care. Declines in antipsychotic prescribing were greater for residents with dementia, with similar rates among residents enrolled and not enrolled in hospice. Among residents with dementia enrolled in hospice, use of other psychotropic medication classes including antianxiety, antidepressant, and hypnotic use remained relatively stable over time.Conclusions and relevanceDeclines in antipsychotic prescribing during the CMS National Partnership occurred among long-term care residents in hospice, where use may be deemed clinically appropriate. Nursing homes are an important location for the provision of dementia end-of-life care and the drivers of potentially unintended reductions in antipsychotic use merits further investigation.

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Factors associated with drug prescribing practices in long-term care patients with cognitive impairment.

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Factors associated with drug prescribing practices in long-term care patients with cognitive impairment.

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