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Zhaojian W, Meizhu J, Jun H, Shanshan G, Jiping H, Zhigang Z, Ying G, Cao L. Trends and off-label utilization of antipsychotics in children and adolescents from 2016 to 2021 in China: a real-world study. Child Adolesc Psychiatry Ment Health 2024; 18:77. [PMID: 38907356 PMCID: PMC11193198 DOI: 10.1186/s13034-024-00766-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 06/06/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Global antipsychotic usage, including off-label prescriptions, has increased in recent decades. However, trends in China, particularly for children and adolescents, remain unclear. This study explored these trends from 2016 to 2021 and identified factors associated with off-label prescriptions. METHODS In this retrospective study, we analyzed on-label and off-label prescriptions based on drug information approved by the China National Medical Products Administration. To identify factors associated with off-label prescriptions, we conducted multivariate logistic regression analysis. RESULTS Our study included 48,258 antipsychotic prescriptions, 52.4% (25,295) of which were prescriptions for males. Of these, 61.7% (29,813) were off-label. Over time, the number of antipsychotics and the percentage of off-label prescriptions for children and adolescents overall increased from 2016 to 2021. The use of atypical antipsychotics increased, whereas that of typical antipsychotics decreased. For off-label usage, all of the factors in our study were associated with off-label usage, including age, sex, year, region, department, reimbursement, antipsychotic type, drug expense, number of polypharmacy and diagnoses. Additionally, tiapride (15.8%) and aripiprazole (18.6%) were the most common typical and atypical antipsychotics, respectively. For pediatric diseases, common diagnoses included mood or affective disorders (31.7%) and behavioral and emotional disorders, with onset usually occurring in childhood and adolescence (29.1%). Furthermore, a depressive state was the most common diagnosis for which antipsychotic polypharmacy was used for treatment. CONCLUSION In this retrospective study, off-label antipsychotic prescriptions were common, with trends generally increasing among children and adolescents from 2016 to 2021. However, there is a lack of evidence supporting off-label usage, thus emphasizing the need for studies on the efficacy and safety of these treatments.
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Affiliation(s)
- Wang Zhaojian
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Jiang Meizhu
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nan Si Huan Xi Lu, Fengtai District, 100050, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Hong Jun
- Department of Pharmacy, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Clinical Pharmacology, School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Guo Shanshan
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nan Si Huan Xi Lu, Fengtai District, 100050, Beijing, China
| | - Huo Jiping
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nan Si Huan Xi Lu, Fengtai District, 100050, Beijing, China
| | - Zhao Zhigang
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nan Si Huan Xi Lu, Fengtai District, 100050, Beijing, China
| | - Gong Ying
- Department of Pharmacy, Dongfang Hospital, Beijing University of Chinese Medicine, No. 6, Phase 1, Fangxingyuan, Fangzhuang, Fengtai District, Beijing, China.
| | - Li Cao
- Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, 119 Nan Si Huan Xi Lu, Fengtai District, 100050, Beijing, China.
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Sluggett JK, Caughey GE, Air T, Cations M, Lang CE, Ward SA, Ahern S, Lin X, Wallis K, Crotty M, Inacio MC. National surveillance using a clinical quality indicator for prolonged antipsychotic use among older Australians with dementia who access aged care services. Int J Geriatr Psychiatry 2024; 39:e6089. [PMID: 38676658 DOI: 10.1002/gps.6089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 04/09/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVES Dementia guidelines recommend antipsychotics are only used for behavioral and psychological symptoms when non-drug interventions fail, and to regularly review use. Population-level clinical quality indicators (CQIs) for dementia care in permanent residential aged care (PRAC) typically monitor prevalence of antipsychotic use but not prolonged use. This study aimed to develop a CQI for antipsychotic use >90 days and examine trends, associated factors, and variation in CQI incidence; and examine duration of the first episode of use among individuals with dementia accessing home care packages (HCPs) or PRAC. METHODS Retrospective cohort study, including older individuals with dementia who accessed HCPs (n = 50,257) or PRAC (n = 250,196). Trends in annual CQI incidence (2011-12 to 2015-16) and associated factors were determined using Poisson regression. Funnel plots examined geographical and facility variation. Time to antipsychotic discontinuation was estimated among new antipsychotic users accessing HCP (n = 2367) and PRAC (n = 15,597) using the cumulative incidence function. RESULTS Between 2011-12 and 2015-16, antipsychotic use for >90 days decreased in HCP recipients from 10.7% (95% CI 10.2-11.1) to 10.1% (95% CI 9.6-10.5, adjusted incidence rate ratio (aIRR) 0.97 (95% CI 0.95-0.98)), and in PRAC residents from 24.5% (95% CI 24.2-24.7) to 21.8% (95% CI 21.5-22.0, aIRR 0.97 (95% CI 0.96-0.98)). Prior antipsychotic use (both cohorts) and being male and greater socioeconomic disadvantage (PRAC cohort) were associated with higher CQI incidence. Little geographical/facility variation was observed. Median treatment duration in HCP and PRAC was 334 (interquartile range [IQR] 108-958) and 555 (IQR 197-1239) days, respectively. CONCLUSIONS While small decreases in antipsychotic use >90 days were observed between 2011-12 and 2015-16, findings suggest antipsychotic use among aged care recipients with dementia can be further minimized.
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Affiliation(s)
- Janet K Sluggett
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Gillian E Caughey
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Tracy Air
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Monica Cations
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Catherine E Lang
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Stephanie A Ward
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, The Prince of Wales Hospital, Randwick, New South Wales, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Maria C Inacio
- University of South Australia, UniSA Allied Health and Human Performance, Adelaide, South Australia, Australia
- Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
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3
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Mok PLH, Carr MJ, Guthrie B, Morales DR, Sheikh A, Elliott RA, Camacho EM, van Staa T, Avery AJ, Ashcroft DM. Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. BMJ 2024; 385:e076268. [PMID: 38631737 PMCID: PMC11022137 DOI: 10.1136/bmj-2023-076268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To investigate risks of multiple adverse outcomes associated with use of antipsychotics in people with dementia. DESIGN Population based matched cohort study. SETTING Linked primary care, hospital and mortality data from Clinical Practice Research Datalink (CPRD), England. POPULATION Adults (≥50 years) with a diagnosis of dementia between 1 January 1998 and 31 May 2018 (n=173 910, 63.0% women). Each new antipsychotic user (n=35 339, 62.5% women) was matched with up to 15 non-users using incidence density sampling. MAIN OUTCOME MEASURES The main outcomes were stroke, venous thromboembolism, myocardial infarction, heart failure, ventricular arrhythmia, fracture, pneumonia, and acute kidney injury, stratified by periods of antipsychotic use, with absolute risks calculated using cumulative incidence in antipsychotic users versus matched comparators. An unrelated (negative control) outcome of appendicitis and cholecystitis combined was also investigated to detect potential unmeasured confounding. RESULTS Compared with non-use, any antipsychotic use was associated with increased risks of all outcomes, except ventricular arrhythmia. Current use (90 days after a prescription) was associated with elevated risks of pneumonia (hazard ratio 2.19, 95% confidence interval (CI) 2.10 to 2.28), acute kidney injury (1.72, 1.61 to 1.84), venous thromboembolism (1.62, 1.46 to 1.80), stroke (1.61, 1.52 to 1.71), fracture (1.43, 1.35 to 1.52), myocardial infarction (1.28, 1.15 to 1.42), and heart failure (1.27, 1.18 to 1.37). No increased risks were observed for the negative control outcome (appendicitis and cholecystitis). In the 90 days after drug initiation, the cumulative incidence of pneumonia among antipsychotic users was 4.48% (4.26% to 4.71%) versus 1.49% (1.45% to 1.53%) in the matched cohort of non-users (difference 2.99%, 95% CI 2.77% to 3.22%). CONCLUSIONS Antipsychotic use compared with non-use in adults with dementia was associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, but not ventricular arrhythmia. The range of adverse outcomes was wider than previously highlighted in regulatory alerts, with the highest risks soon after initiation of treatment.
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Affiliation(s)
- Pearl L H Mok
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew J Carr
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Daniel R Morales
- Population Health and Genomics, University of Dundee, Dundee, UK
| | - Aziz Sheikh
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel A Elliott
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Manchester Centre for Health Economics, Division of Population Health, Manchester, UK
| | - Elizabeth M Camacho
- Manchester Centre for Health Economics, Division of Population Health, Manchester, UK
| | - Tjeerd van Staa
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Anthony J Avery
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Centre for Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
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McDermid J, Henley W, Corbett A, Williams G, Fossey J, Clare L, Fox C, Aarsland D, Khan Z, Soto M, Woodward‐Carlton B, Cook EM, Cummings J, Sweetnam A, Chan X, Lawrence M, Ballard C. Impact of the iWHELD digital person-centered care program on quality of life, agitation and psychotropic medications in people with dementia living in nursing homes during the COVID-19 pandemic: A randomized controlled trial. Alzheimers Dement 2024; 20:1797-1806. [PMID: 38116916 PMCID: PMC10984502 DOI: 10.1002/alz.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/19/2023] [Accepted: 10/29/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION iWHELD is a digital person-centered care program for people with dementia in nursing homes adapted for remote delivery during the COVID-19 pandemic. METHODS A 16-week two-arm cluster-randomized controlled trial in 149 UK nursing homes compared iWHELD with treatment as usual (TAU). Primary outcome was the overall quality of life with secondary outcomes of agitation and psychotropic use. RESULTS iWHELD conferred benefit to quality of life on the primary (F = 4.3, p = 0.04) and secondary measures of quality of life (F = 6.45, p = 0.01) and reduced psychotropic medication use (χ2 = 4.08, p = 0.04) with no worsening of agitation. Benefit was seen in participants who contracted COVID-19, those with agitation at baseline, and those taking psychotropic medications. DISCUSSION iWHELD confers benefits to quality of life and key measures of well-being, can be delivered during the challenging conditions of a pandemic, and should be considered for use alongside any emerging pharmacological treatment for neuropsychiatric symptoms. HIGHLIGHTS iWHELD is the only remote, digital delivery nursing home training programme for dementia care iWHELD improved quality of life in people with dementia and reduced antipsychotic use without worsening of agitation Residents who contracted Covid-19 during the study also experienced benefits from iWHELD iWHELD offers a valuable, pandemic-safe tool for improving dementia care.
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Affiliation(s)
- Joanne McDermid
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
- Institute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
| | - William Henley
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Anne Corbett
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Gareth Williams
- Institute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
| | - Jane Fossey
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Linda Clare
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
- NIHR Applied Research Collaboration South‐West PeninsulaUniversity of ExeterExeterUK
| | - Chris Fox
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Dag Aarsland
- Institute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
| | - Zunera Khan
- Institute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
| | - Maria Soto
- Research and Clinical Alzheimer's Disease CenterCMRR Gérontopôle, CHU Toulouse, AGING teamaxe MAINTAIN CERPOPToulouseFrance
| | | | | | - Jeffrey Cummings
- Chambers‐Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health SciencesUniversity of Nevada Las Vegas (UNLV)Las VegasNevadaUSA
| | | | - Xavier Chan
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Megan Lawrence
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Clive Ballard
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
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Maxwell CJ, Dampf H, Alkabbani W, Cotton CA, Gamble JM, Hogan DB, Gruneir A, McArthur E, Youngson E, Hsu Z, Hoben M. Psychotropic, Anticonvulsant, and Opioid Use in Assisted Living Residents Before and During the COVID-19 Pandemic. J Am Med Dir Assoc 2024; 25:121-129. [PMID: 37863111 DOI: 10.1016/j.jamda.2023.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/04/2023] [Accepted: 09/12/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVES To examine the associations between COVID-19 pandemic waves (1-4) and prevalent antipsychotic, antidepressant, benzodiazepine, anticonvulsant, and opioid use among assisted living (AL) residents, by setting (dementia care vs other). DESIGN Population-based, repeated cross-sectional study. SETTING AND PARTICIPANTS Linked clinical and health administrative databases for residents of all publicly subsidized AL homes (N = 256) in Alberta, Canada, examined from January 2018 to December 2021. Setting-specific quarterly cohorts of residents were derived for pandemic (starting March 1, 2020) and comparable historical (2018/2019 combined) periods. METHODS The quarterly proportion of residents dispensed an antipsychotic, antidepressant, benzodiazepine, anticonvulsant, or opioid was examined for each setting and period. Log-binomial generalized estimating equations models estimated prevalence ratios (PR) for period (pandemic vs historical quarterly periods), setting (dementia care vs other AL), and period-setting interactions. RESULTS On March 1, 2020, there were 2874 dementia care and 6611 other AL residents (mean age 82.4 vs 79.9 years, 68.2% vs 66.1% female, 93.5% vs 42.6% with dementia, respectively). Antipsychotic use increased during waves 2 to 4 for residents of both settings, but this increase was significantly greater for dementia care than other AL residents during waves 3 and 4 (eg, wave 3, PR 1.21, 95% CI 1.14-1.27 vs PR 1.12, 95% CI 1.07-1.17, interaction term P = .029). In both settings, there was a significant but modest increase in antidepressant use and a significant decrease in benzodiazepine use during several pandemic waves. For other AL residents only, there was a small statistically significant increase in anticonvulsant use during waves 2 to 4. No significant pandemic effect was observed for prevalent opioid use in either setting. CONCLUSIONS AND IMPLICATIONS The persistence of the pandemic-associated increase in antipsychotic, antidepressant, and anticonvulsant use in AL residents, and greater increase in antipsychotic use for dementia care settings, raises concerns about the attendant risks for residents, especially those with dementia.
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Affiliation(s)
- Colleen J Maxwell
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada.
| | - Hana Dampf
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Wajd Alkabbani
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
| | - Cecilia A Cotton
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | | | - David B Hogan
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Gruneir
- ICES, Toronto, Ontario, Canada; Department of Family Medicine, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Eric McArthur
- London Health Sciences Centre, London, Ontario, Canada
| | - Erik Youngson
- Provincial Research Data Services, Alberta Health Services, Alberta, Edmonton, Canada; Data and Research Services, Alberta SPOR SUPPORT Unit, Alberta, Edmonton, Canada
| | - Zoe Hsu
- Provincial Research Data Services, Alberta Health Services, Alberta, Edmonton, Canada; Data and Research Services, Alberta SPOR SUPPORT Unit, Alberta, Edmonton, Canada
| | - Matthias Hoben
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada; School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
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6
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Hoben M, Hogan DB, Poss JW, Gruneir A, McGrail K, Griffith LE, Chamberlain SA, Estabrooks CA, Maxwell CJ. Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID-19 pandemic. J Am Geriatr Soc 2023; 71:3467-3479. [PMID: 37428008 DOI: 10.1111/jgs.18499] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/22/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID-19 pandemic. Our study compared trends of practice-sensitive, risk-adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic. METHODS This repeated cross-sectional study used population-based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017-12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk-adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late-loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic. RESULTS Quarterly samples included 2015-2710 AL residents and 12,881-13,807 NH residents. Antipsychotic use (21%-26%), pain (20%-24%), and depressive symptoms (17%-25%) were most common in AL. In NHs, they were physical dependency (33%-36%), depressive symptoms (26%-32%), and antipsychotic use (17%-22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%-1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%-0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%-0.8%], p = 0.0222). CONCLUSIONS QIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact.
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Affiliation(s)
- Matthias Hoben
- School of Health Policy and Management, Faculty of Health, York University, Toronto, Ontario, Canada
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - David B Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeffrey W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
- ICES, Toronto, Ontario, Canada
| | - Kim McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Colleen J Maxwell
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- School of Pharmacy, University of Waterloo, Waterloo, Ontario, Canada
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Ballard C, Corbett A. Antipsychotic drug presribing in dementia: changes from the pandemic. THE LANCET. HEALTHY LONGEVITY 2023; 4:e366-e367. [PMID: 37543045 DOI: 10.1016/s2666-7568(23)00131-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 08/07/2023] Open
Affiliation(s)
- Clive Ballard
- Clinical and Biomedical Sciences, University of Exeter, Exeter EX1 2LU, UK.
| | - Anne Corbett
- Health and Community Sciences, University of Exeter, Exeter EX1 2LU, UK
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8
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Wang HJ, Kusumo RW, Kiss A, Tennen G, Marotta G, Viaje S, Lanctôt KL. Characterizing PRN Use of Psychotropic Medications for Acute Agitation in Canadian Long-Term Care Residents with Dementia Before and During COVID-19. J Alzheimers Dis Rep 2023; 7:575-587. [PMID: 37313488 PMCID: PMC10259051 DOI: 10.3233/adr-230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/15/2023] [Indexed: 06/15/2023] Open
Abstract
Background Agitation is a disabling neuropsychiatric symptom of dementia. Pro re nata (PRN) injections of psychotropics can be administered for severe acute agitation, but little is known about the frequency of their actual use. Objective Characterize actual use of injectable PRN psychotropics for severe acute agitation in Canadian long-term care (LTC) residents with dementia and compare use before and during the COVID-19 pandemic. Methods Residents from two Canadian LTC facilities with orders for PRN haloperidol, olanzapine, or lorazepam between January 1, 2018- May 1, 2019 (i.e., pre-COVID-19) and January 1, 2020- May 1, 2021 (i.e., COVID-19) were identified. Electronic medical records were reviewed to document PRN injections of psychotropic medications and collect data on reason and demographic characteristics. Descriptive statistics were used to characterize frequency, dose, and indications of use, and multivariate regression models were used to compare use between time periods. Results Of the 250 residents, 45 of 103 (44%) people in the pre-COVID-19 period and 85 of 147 (58%) people in the COVID-19 period with standing orders for PRN psychotropics received ≥1 injections. Haloperidol was the most frequently used agent in both time periods (74% (155/209 injections) pre-COVID-19; 81% (323/398 injections) during COVID-19). Residents in the COVID-19 period were almost two times more likely to receive injections compared with those in the pre-COVID-19 period (odds ratio = 1.96; 95% CI = 1.15-3.34; p = 0.01). Conclusion Our results suggest that use of PRN injections increased in LTC during the pandemic and contribute to the mounting evidence that agitation worsened during that time.
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Affiliation(s)
- Hui Jue Wang
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Raphael W. Kusumo
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Gayla Tennen
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
| | - Giovanni Marotta
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Geriatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Villa Colombo Homes for the Aged Inc, North York, ON, Canada
| | - Shirley Viaje
- Villa Colombo Homes for the Aged Inc, North York, ON, Canada
| | - Krista L. Lanctôt
- Neuropsychopharmacology Research Group, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON Canada
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9
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Turcotte LA, McArthur C, Poss JW, Heckman G, Mitchell L, Morris J, Foebel AD, Hirdes JP. Long-Term Care Resident Health and Quality of Care During the COVID-19 Pandemic: A Synthesis Analysis of Canadian Institute for Health Information Data Tables. Health Serv Insights 2023; 16:11786329231174745. [PMID: 37220547 PMCID: PMC10196682 DOI: 10.1177/11786329231174745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Objective Long-term care (LTC) homes ("nursing homes") were challenged during the first year of the COVID-19 pandemic in Canada. The objective of this study was to measure the impact of the COVID-19 pandemic on resident admission and discharge rates, resident health attributes, treatments, and quality of care. Design Synthesis analysis of "Quick Stats" standardized data table reports published yearly by the Canadian Institute for Health Information. These reports are a pan-Canadian scorecard of LTC services rendered, resident health characteristics, and quality indicator performance. Setting and participants LTC home residents in Alberta, British Columbia, Manitoba, and Ontario, Canada that were assessed with the interRAI Minimum Data Set 2.0 comprehensive health assessment in fiscal years 2018/2019, 2019/2020 (pre-pandemic period), and 2020/2021 (pandemic period). Methods Risk ratio statistics were calculated to compare admission and discharge rates, validated interRAI clinical summary scale scores, medication, therapy and treatment provision, and seventeen risk-adjusted quality indicator rates from the pandemic period relative to prior fiscal years. Results Risk of dying in the LTC home was greater in all provinces (risk ratio [RR] range 1.06-1.18) during the pandemic. Quality of care worsened substantially on 6 of 17 quality indicators in British Columbia and Ontario, and 2 quality indicators in Manitoba and Alberta. The only quality indicator where performance worsened during the pandemic in all provinces was the percentage of residents that received antipsychotic medications without a diagnosis of psychosis (RR range 1.01-1.09). Conclusions and implications The COVID-19 pandemic has unveiled numerous areas to strengthen LTC and ensure that resident's physical, social, and psychological needs are addressed during public health emergencies. Except an increase in potentially inappropriate antipsychotic use, this provincial-level analysis indicates that most aspects of resident care were maintained during the first year of the COVID-19 pandemic.
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Affiliation(s)
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Jeff W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lori Mitchell
- Home Care Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | | | - Andrea D Foebel
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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