Document Type

Article

Peer Reviewed

1

Publication Date

3-6-2017

NLM Title Abbreviation

Alzheimers Dement (N Y)

Journal/Book/Conference Title

Alzheimer's & Dementia: Translational Research & Clinical Interventions

PubMed ID

29124114

DOI of Published Version

10.1016/j.trci.2017.02.003

Total Pages

9

Abstract

Introduction: Antipsychotics are used for managing behavioral and psychological symptoms of dementia (BPSD) but have risks. Anticholinergics can worsen outcomes in dementia. The Improving Antipsychotic Appropriateness in Dementia Patients educational program (IA-ADAPT) and Centers for Medicare and Medicaid Services Partnership to Improve Dementia Care (CMS Partnership) promote improved care for BPSD. The purpose of this study was to evaluate the impact of these programs on medication use and BPSD among nursing home residents.

Methods: This quasi-experimental longitudinal study used Medicare and assessment data for Iowa nursing home residents from April 2011 to December 2012. Residents were required to be eligible for six continuous months for inclusion. Antipsychotic use and anticholinergic use were evaluated on a monthly basis, and changes in BPSD were tracked using assessment data. Results are presented as odds ratios (ORs) per month after exposure to the IA-ADAPT or the start of the CMS Partnership.

Results: Of 426 eligible Iowa nursing homes, 114 were exposed to the IA-ADAPT in 2012. Nursing home exposure to the IA-ADAPT was associated with reduced antipsychotic use (OR [95% CI] = 0.92 [0.89-0.95]) and anticholinergic use (OR [95% CI] = 0.95 [0.92-0.98]), reduced use of excessive antipsychotic doses per CMS guidance (OR [95% CI] = 0.80 [0.75-0.86]), increased odds of a potentially appropriate indication among antipsychotic users (OR [95% CI] = 1.04 [1.00-1.09]), and decreased documentation of verbal aggression (OR [95% CI] = 0.96 [0.94-0.99]). Facilities with two or more IA-ADAPT exposures had greater reductions in antipsychotic and anticholinergic use than those with only one. The CMS Partnership was associated with reduced antipsychotic use (OR [95% CI] = 0.96 [0.94-0.98]) and decreased documentation of any measured BPSD (OR [95% CI] = 0.98 [0.97-0.99]) as well as delirium specifically (OR [95% CI] = 0.98 [0.96-0.99]).

Discussion: This study suggests that the IA-ADAPT and the CMS Partnership improved medication use with no adverse impact on BPSD.

Keywords

OAfund, Antipsychotics; Anticholinergics, Dementia, Nursing home, Education

Granting or Sponsoring Agency

Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services grant R18HS019355, Patient- Centered Outcomes Research Institute (PCORI) program award (1131)

Grant Number

R18HS019355; 1131

Journal Article Version

Proof

Published Article/Book Citation

Alzheimer's & Dementia: Translational Research & Clinical Interventions 3(2017) 553-561

https://doi.org/10.1016/j.trci.2017.02.003

Rights

Copyright (c) 2017 The Authors

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Included in

Epidemiology Commons

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URL

http://ir.uiowa.edu/epi_pubs/4