Variation and Correlation of Potential Unintended Consequences of Antipsychotic Reduction in Ontario Nursing Homes Over Time.
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
01 03 2023
01 03 2023
Historique:
pubmed:
3
2
2023
medline:
17
2
2023
entrez:
2
2
2023
Statut:
ppublish
Résumé
Potentially inappropriate antipsychotic use has declined in nursing homes over the past decade; however, increases in the documentation of relevant clinical indications (eg, delusions) and the use of other psychotropic medications have raised concerns about diagnosis upcoding and medication substitution. Few studies have examined how these trends over time vary across and within nursing homes, information that may help to support antipsychotic reduction efforts. To jointly model facility-level time trends in potentially inappropriate antipsychotic use, antidepressant use, and the indications used to define appropriate antipsychotic use. We conducted a repeated cross-sectional study of all nursing homes in Ontario, Canada between April 1, 2010 and December 31, 2019 using linked health administrative data (N=649). Each nursing home's quarterly prevalence of potentially inappropriate antipsychotic use, antidepressant use, and relevant indications were measured as outcome variables. With time as the independent variable, multivariate random effects models jointly estimated time trends for each outcome across nursing homes and the correlations between time trends within nursing homes. We observed notable variations in the time trends for each outcome across nursing homes, especially for the relevant indications. Within facilities, we found no correlation between time trends for potentially inappropriate antipsychotic and antidepressant use ( r =-0.0160), but a strong negative correlation between time trends for potentially inappropriate antipsychotic use and relevant indications ( r =-0.5036). Nursing homes with greater reductions in potentially inappropriate antipsychotics tended to show greater increases in the indications used to define appropriate antipsychotic use-possibly leading to unmonitored use of antipsychotics.
Sections du résumé
BACKGROUND
Potentially inappropriate antipsychotic use has declined in nursing homes over the past decade; however, increases in the documentation of relevant clinical indications (eg, delusions) and the use of other psychotropic medications have raised concerns about diagnosis upcoding and medication substitution. Few studies have examined how these trends over time vary across and within nursing homes, information that may help to support antipsychotic reduction efforts.
OBJECTIVE
To jointly model facility-level time trends in potentially inappropriate antipsychotic use, antidepressant use, and the indications used to define appropriate antipsychotic use.
RESEARCH DESIGN
We conducted a repeated cross-sectional study of all nursing homes in Ontario, Canada between April 1, 2010 and December 31, 2019 using linked health administrative data (N=649). Each nursing home's quarterly prevalence of potentially inappropriate antipsychotic use, antidepressant use, and relevant indications were measured as outcome variables. With time as the independent variable, multivariate random effects models jointly estimated time trends for each outcome across nursing homes and the correlations between time trends within nursing homes.
RESULTS
We observed notable variations in the time trends for each outcome across nursing homes, especially for the relevant indications. Within facilities, we found no correlation between time trends for potentially inappropriate antipsychotic and antidepressant use ( r =-0.0160), but a strong negative correlation between time trends for potentially inappropriate antipsychotic use and relevant indications ( r =-0.5036).
CONCLUSIONS
Nursing homes with greater reductions in potentially inappropriate antipsychotics tended to show greater increases in the indications used to define appropriate antipsychotic use-possibly leading to unmonitored use of antipsychotics.
Identifiants
pubmed: 36728617
doi: 10.1097/MLR.0000000000001814
pii: 00005650-202303000-00009
doi:
Substances chimiques
Antipsychotic Agents
0
Psychotropic Drugs
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
173-181Subventions
Organisme : CIHR
Pays : Canada
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflict of interest.
Références
Centers for Medicare & Medicaid Services. National Partnership to Improve Dementia Care in nursing homes. 2021. Accessed October 13, 2021. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/National-Partnership-to-Improve-Dementia-Care-in-Nursing-Homes
Ivers NM, Taljaard M, Giannakeas V, et al. Public reporting of antipsychotic prescribing in nursing homes: population-based interrupted time series analyses. BMJ Qual Saf. 2019;28:121–131.
Maust DT, Kim HM, Chiang C, et al. Association of the Centers for Medicare & Medicaid Services’ National Partnership to Improve Dementia Care with the use of antipsychotics and other psychotropics in long-term care in the United States from 2009 to 2014. JAMA Intern Med. 2018;178:640–647.
Canadian Institute for Health Information. Potentially inappropriate use of antipsychotics in long-term care. 2021. Accessed October 13, 2021. https://yourhealthsystem.cihi.ca/hsp/inbrief?lang=en#!/indicators/008/potentially-inappropriate-use-of-antipsychotics-in-long-term-care/;mapC1;mapLevel2;/
Dorsey ER, Rabbani A, Gallagher SA, et al. Impact of FDA black box advisory on antipsychotic medication use. Arch Intern Med. 2010;170:96–103.
Valiyeva E, Herrmann N, Rochon PA, et al. Effect of regulatory warnings on antipsychotic prescription rates among elderly patients with dementia: a population-based time-series analysis. CMAJ. 2008;179:438–446.
American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers Criteria(R) for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2019;67:674–694.
Herrmann N, Lanctot KL, Hogan DB. Pharmacological recommendations for the symptomatic treatment of dementia: the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. Alzheimers Res Ther. 2013;5(suppl 1):S5.
Harris DA, Maclagan LC, Iaboni A, et al. Potential unintended consequences of antipsychotic reduction in Ontario nursing homes. J Am Med Dir Assoc. 2022;23:1066–1072.
Winter JD, Kerns JW, Winter KM, et al. Increased reporting of exclusionary diagnoses inflate apparent reductions in long-stay antipsychotic prescribing. Clin Gerontol. 2019;42:297–301.
Briesacher BA, Mui B, Devlin JW, et al. Nursing homes underreport antipsychotic prescribing. Aging Ment Health. 2020;24:668–672.
Fashaw-Walters SA, McCreedy E, Bynum JPW, et al. Disproportionate increases in schizophrenia diagnoses among Black nursing home residents with ADRD. J Am Geriatr Soc. 2021;69:3623–3630.
Konetzka RT, Brauner DJ, Coca Perraillon M, et al. The role of severe dementia in nursing home report cards. Med Care Res Rev. 2015;72:562–579.
Gerlach LB, Kales HC, Kim HM, et al. Trends in antipsychotic and mood stabilizer prescribing in long-term care in the U.S.: 2011-2014. J Am Med Dir Assoc. 2020;21:1629–1635. e1628.
Iaboni A, Bronskill SE, Reynolds KB, et al. Changing pattern of sedative use in older adults: a population-based cohort study. Drugs Aging. 2016;33:523–533.
Vasudev A, Shariff SZ, Liu K, et al. Trends in psychotropic dispensing among older adults with dementia living in long-term care facilities: 2004-2013. Am J Geriatr Psychiatry. 2015;23:1259–1269.
Rochon PA, Stukel TA, Bronskill SE, et al. Variation in nursing home antipsychotic prescribing rates. Arch Intern Med. 2007;167:676–683.
Chen Y, Briesacher BA, Field TS, et al. Unexplained variation across US nursing homes in antipsychotic prescribing rates. Arch Intern Med. 2010;170:89–95.
Bronskill SE, Rochon PA, Gill SS, et al. The relationship between variations in antipsychotic prescribing across nursing homes and short-term mortality: quality of care implications. Med Care. 2009;47:1000–1008.
Huybrechts KF, Rothman KJ, Brookhart MA, et al. Variation in antipsychotic treatment choice across US nursing homes. J Clin Psychopharmacol. 2012;32:11–17.
Tjia J, Gurwitz JH, Briesacher BA. Challenge of changing nursing home prescribing culture. Am J Geriatr Pharmacother. 2012;10:37–46.
Cioltan H, Alshehri S, Howe C, et al. Variation in use of antipsychotic medications in nursing homes in the United States: a systematic review. BMC Geriatr. 2017;17:32.
Lucas JA, Chakravarty S, Bowblis JR, et al. Antipsychotic medication use in nursing homes: a proposed measure of quality. Int J Geriatr Psychiatry. 2014;29:1049–1061.
Iaboni A, Campitelli MA, Bronskill SE, et al. Time trends in opioid prescribing among Ontario long-term care residents: a repeated cross-sectional study. CMAJ Open. 2019;7:E582–E589.
Moore A, Patterson C, Lee L, et al. Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia: recommendations for family physicians. Can Fam Physician. 2014;60:433–438.
Perlman CM, Hirdes JP. The aggressive behavior scale: a new scale to measure aggression based on the minimum data set. J Am Geriatr Soc. 2008;56:2298–2303.
Morris JN, Fries BE, Mehr DR, et al. MDS cognitive performance scale. J Gerontol. 1994;49:M174–M182.
Statistics Canada. Postal CodeOM Conversion File Plus (PCCF+) Version 6C, Reference Guide. Ottawa: Minister of Industry; 2016.
Gebregziabher M, Zhao Y, Dismuke CE, et al. Joint modeling of multiple longitudinal cost outcomes using multivariate generalized linear mixed models. Health Serv Outcomes Res Methodol. 2013;13:39–57.
Verbeke G, Fieuws S, Molenberghs G, et al. The analysis of multivariate longitudinal data: a review. Stat Methods Med Res. 2014;23:42–59.
Fieuws S, Verbeke G, Molenberghs G. Random-effects models for multivariate repeated measures. Stat Methods Med Res. 2007;16:387–397.
Pituch KA, Stevens JP. Applied multivariate statistics for the social sciences: analyses with SAS and IBM's SPSS. 6th Edition. Routledge; 2015.
Austin PC, Lee DS, Leckie G. Comparing a multivariate response Bayesian random effects logistic regression model with a latent variable item response theory model for provider profiling on multiple binary indicators simultaneously. Stat Med. 2020;39:1390–1406.
Austin PC, Fang J, Yu B, et al. Examining hospital variation on multiple indicators of stroke quality of care. Circ Cardiovasc Qual Outcomes. 2020;13:e006968.
Bruser D, Mclean J. Use of antipsychotics soaring at Ontario nursing homes Toronto. Toronto Star. Toronto, ON: Toronto Star Newspapers Ltd.; 2014. Aceesed November 5, 2021. https://www.thestar.com/news/canada/2014/04/15/use_of_antipsychotics_soaring_at_ontario_nursing_homes.html
Neufeld E, Freeman S, Spirgiene L, et al. A cross-sectoral comparison of prevalence and predictors of symptoms of depression over time among older adults in Ontario, Canada. J Geriatr Psychiatry Neurol. 2021;34:11–20.
Camargos EF, Louzada LL, Quintas JL, et al. Trazodone improves sleep parameters in Alzheimer disease patients: a randomized, double-blind, and placebo-controlled study. Am J Geriatr Psychiatry. 2014;22:1565–1574.
Thomas K, Gebeloff R, Silver-Greenberg J. Phony diagnoses hide high rates of drugging at nursing homes. 2021. Accessed November 5, 2021. https://www.nytimes.com/2021/09/11/health/nursing-homes-schizophrenia-antipsychotics.html
Office of Inspector General. CMS could improve the data it uses to monitor antipsychotic drugs in nursing homes. 2021. Accessed November 4, 2021. https://oig.hhs.gov/oei/reports/OEI-07-19-00490.asp
Castle NG, Hanlon JT, Handler SM. Results of a longitudinal analysis of national data to examine relationships between organizational and market characteristics and changes in antipsychotic prescribing in US nursing homes from 1996 through 2006. Am J Geriatr Pharmacother. 2009;7:143–150.
Hanlon JT, Handler SM, Castle NG. Antidepressant prescribing in US nursing homes between 1996 and 2006 and its relationship to staffing patterns and use of other psychotropic medications. J Am Med Dir Assoc. 2010;11:320–324.