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Res Social Adm Pharm. 2014 May-Jun;10(3):494-507. doi: 10.1016/j.sapharm.2013.10.003. Epub 2013 Nov 15.

Quality of psychopharmacological medication use in nursing home residents.

Author information

1
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
2
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA. Electronic address: ywei@rx.umaryland.edu.
3
Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Fairleigh Dickinson University School of Pharmacy, Florham Park, NJ, USA.
4
Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.
5
Department of Behavioral and Community Health, Seton Hall University College of Nursing, South Orange, NJ, USA; Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA.

Abstract

BACKGROUND:

Despite well-documented evidence regarding antipsychotic use in older adults residing in nursing homes (NHs), there is a lack of evidence-based use and quality benchmarks for other psychopharmacological medications (PPMs), including antidepressants, anxiolytics, and sedative-hypnotics.

OBJECTIVE:

To estimate the prevalence and patterns of use of PPMs and to measure the quality of PPM use.

METHODS:

Using a 5% random sample of 2007 Medicare claims data linked to the Minimum Data Set 2.0, this cross-sectional study identified a nationally representative sample of 69,832 NH residents with ≥3 months of institutionalization. This study measured 1-year prevalence and quality of PPM use, as assessed by indication, dose, and duration of use defined and operationalized according to the current Centers for Medicare and Medicaid Services Unnecessary Medication Guidance for Surveyors and relevant practice guidelines.

RESULTS:

Over two-thirds of residents (72.1%, n=50,349) used ≥1 PPM in 2007, with the highest prevalence seen in antidepressants (59.4%), and the lowest in anxiolytics (8.9%). Almost two-thirds (61.0%) of PPM users used ≥2 PPM classes. Compared to other PPM therapeutic classes, antipsychotic users had greatest evidence of guideline adequate use by indication (95.8%) and dose (78.7%). In addition, longer duration of adequate treatment was observed among antipsychotic users (mean = 208 days, standard deviation [SD] = 118) as compared to anxiolytic (mean = 159 days, SD = 118) and sedative-hypnotic users (mean = 183 days, SD = 117).

CONCLUSIONS:

This study found that PPM use remains highly prevalent among long-stay Medicare NH residents. While antipsychotic use remained high (31.5%), little antipsychotic use was deemed inadequate by indication. However, the 1-year prevalence of use, dose, and duration of use of other PPMs remain high and potentially inadequate. Practitioners and policy-makers should heed both the high use and lower prescribing quality of antidepressants, anxiolytics, and sedative-hypnotics in NH residents.

KEYWORDS:

Nursing homes; Psychopharmacological medications; Quality of medication use

PMID:
24355380
DOI:
10.1016/j.sapharm.2013.10.003
[Indexed for MEDLINE]
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