Antipsychotic prescribing patterns in a Medicare Advantage population of older individuals with dementia

Kester, Rachel; Unützer, Jürgen; Hogan, Diane; Huang, Hsiang

doi:10.1080/09638237.2016.1244720

Cited by 7 publications

(20 citation statements)

References 21 publications

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“…The overall risk of bias was low in 18 studies and moderate in four studies (Table ) . The deficiencies in the studies that had more than a low risk of bias were potential biases due to confounding, missing information about participants at baseline, and low or unreported response rates in surveys.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty‐two studies evaluated determinants of PIM use in community‐dwelling and ambulatory clinic patients . Most studies were either cross‐sectional analyses of claims data or analyses of large nationally representative surveys such as the Medical Expenditure Panel Survey (MEPS) or the National Ambulatory Medical Care Survey (NAMCS) (Tables and ).…”

Section: Resultsmentioning

confidence: 99%

“…Most studies used a broad definition, such as the Beers criteria, to define PIM but eight included studies used a more restrictive definition of PIM such as anticholinergics or potentially inappropriate medications in patients with cognitive disorders (Table ) . Fourteen of the included studies examined actual dispensing data through claims, pharmacy contact or review of actual pill bottles …”

Section: Resultsmentioning

confidence: 99%

“…Nineteen studies evaluated patient factors contributing to PIM use in community‐dwelling adults or those attending ambulatory clinics (Table ). Seventeen used multivariable regression, adjusting for a combination of patient factors, patient and system factors or patient system and clinician factors . Two studies used bivariate analysis …”

Section: Resultsmentioning

confidence: 99%

“…Being a woman was positively associated with PIM use in 10 studies Among the six studies which did not report a statistically significant association between sex and PIM use were two that used bivariate instead of multivariate analysis, a small ( n = 82) study limited to Chinese American older adults in a single city, and two that had a sample that was more than 80% women . However, one study using nationally representative MEPS data did not report a statistically significant association with sex and PIM use when their final multivariate model was adjusted for number of medications …”

Section: Resultsmentioning

confidence: 99%

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Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review†

Nothelle

Sharma

Oakes

et al. 2019

International Journal of Pharmacy Practice

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Objectives Potentially inappropriate medication (PIM) use in older adults is a prevalent problem associated with poor health outcomes. Understanding drivers of PIM use is essential for targeting interventions. This study systematically reviews the literature about the patient, clinician and environmental/system factors associated with PIM use in community‐dwelling older adults in the United States. Methods PRISMA guidelines were followed when completing this review. PubMed and EMBASE were queried from January 2006 to September 2017. Our search was limited to English‐language studies conducted in the United States that assessed factors associated with PIM use in adults ≥65 years who were community‐dwelling. Two independent reviewers screened titles and abstracts. Reviewers abstracted data sequentially and assessed risk of bias independently. Key findings Twenty‐two studies were included. Nineteen examined patient factors associated with PIM use. The most common statistically significant factors associated with PIM use were taking more medications, female sex, and higher outpatient and emergency department utilization. Only three studies examined clinician factors, and few were statistically significant. Fifteen studies examined system‐level factors such as geographic region and health insurance. The most common statistically significant association was the south and west geographic region relative to the northeast United States. Conclusions Amongst older adults, women and persons on more medications are at higher risk of PIM use. There is evidence that increased healthcare use is also associated with PIM use. Future studies are needed exploring clinician factors, such as specialty, and their association with PIM prescribing.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review†

Nothelle

Sharma

Oakes

et al. 2019

International Journal of Pharmacy Practice

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Plan switching among Medicare Advantage beneficiaries with Alzheimer's disease and other dementias

Meyers

Rahman

Rivera‐Hernandez

et al. 2021

A&D Transl Res & Clin Interv

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Introduction Patients with Alzheimer's disease and related dementias (ADRD) face substantial challenges in selecting, and remaining enrolled in, health insurance. Little is known about how patients with ADRD experience the Medicare Advantage (MA) program. Methods We used, hospital, outpatient, and post‐acute care data to identify MA beneficiaries with and without ADRD in 2014. Multinomial logit models estimated the percentage of people who disenrolled to traditional Medicare (TM) or switched to a different MA plan in 2015. Results Among non‐dually eligible beneficiaries, 9.0% (95% confidence interval [CI]: 8.0, 9.1) with ADRD disenrolled while 19.7% (95% CI: 19.6, 19.9) switched plans within MA compared to a disenrollment rate of 4.2% (95% CI: 4.2, 4.2) and switching rate of 22.8% (95% CI: 22.9, 22.8) for persons without ADRD. Discussion MA enrollees with ADRD tend to disenroll at substantially higher rates than those without ADRD. This may be indicative of their care needs not being met in the program.

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Factors Associated with Psychotropic Medication Use in People Living with Dementia in the Community: A Systematic Review and Meta-Analysis

Loftus,

Wand,

Breen

et al. 2023

Drugs Aging

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Background There has been considerable focus on the use of psychotropic agents in people living with dementia in long-term care. However, psychotropic use often commences well before transitioning to long-term care. Objectives To synthesize the available literature to identify factors associated with psychotropic medication use in people living with dementia in the community. Methods This PROSPERO-registered review reports findings from a comprehensive search of Embase, PsycINFO, and PubMed (including MEDLINE) databases according to predefined inclusion and exclusion criteria (2010–2022). Inclusion criteria were original prospective or retrospective design research papers enrolling people diagnosed with dementia utilizing a psychotropic medication and living at home. Quality and risk of bias was assessed Newcastle–Ottawa Quality Assessment Scale. The last search was conducted in November 2022. Thematic analysis was used to synthesize the emergent factors identified, and a meta-analysis was undertaken on suitable data. Results The search identified 619 articles. After review and exclusions, 39 articles were included for synthesis, including 1,338,737 people. The majority of papers (67%) were rated as low risk of bias and corresponding good quality. Thematic analysis suggested associations between psychotropic prescribing and patient and environmental factors, with little data concerning carer and prescriber factors. Such factors included age (< 75 years, > 90 years), sex, more advanced functional decline, and living alone. Meta-analysis identified significant associations between psychotropic use and respite (temporary full-time care or hospitalization) and comorbid psychiatric illness. Conclusions While it is clear from this review that there remains a significant lack of clarity as to the reasons why these medications are being utilized in this population, this review provides greater insight and understanding into the context of psychotropic use. The study has highlighted an opportunity for further targeted research to be conducted and provides a much-needed context for this to occur. PROSPERO Registration Number CRD42021286322. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-023-01070-0.

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Antipsychotic prescribing patterns in a Medicare Advantage population of older individuals with dementia

Abstract: Care management programs under Medicare Advantage have opportunities to address behavioral health needs of older adults with dementia and to limit inappropriate use of antipsychotic medications.

Cited by 7 publications

References 21 publications

Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review†

Factors associated with potentially inappropriate medication use in community-dwelling older adults in the United States: a systematic review†

Plan switching among Medicare Advantage beneficiaries with Alzheimer's disease and other dementias

Factors Associated with Psychotropic Medication Use in People Living with Dementia in the Community: A Systematic Review and Meta-Analysis

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