Todd P Semla1,2, Austin Lee3,4,5, Ronald Gurrera6,7, Laura Bajor7,8, Mingfei Li3, Donald R Miller9, Eric G Smith9,10, Chao Wang11, Yun Wan11, Lewis E Kazis9,12, Mark S Bauer7,9. 1. Pharmacy Benefits Management Services, Department of Veterans Affairs, Hines, Illinois. 2. Departments of Medicine, and Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. 3. Department of Mathematical Sciences, Bentley University, Waltham, Massachusetts. 4. School of Insurance and Economics, University of International Business and Economics, Beijing, China. 5. Massachusetts General Hospital, Boston, Massachusetts. 6. Mental Health Service, Veterans Affairs Boston Healthcare System, Boston, Massachusetts. 7. Department of Psychiatry, Harvard Medical School, Boston, Massachusetts. 8. Center for Organization, Leadership, and Management Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts. 9. Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Bedford, Massachusetts. 10. Departments of Psychiatry and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts. 11. School of Public Health, Boston University, Boston, Massachusetts. 12. Center for the Assessment of Pharmaceutical Practices, Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts.
Abstract
OBJECTIVES: To determine whether elderly veterans with posttraumatic stress disorder (PTSD) and dementia are more likely to be prescribed second-generation antipsychotics (SGAs) than those with PTSD alone. DESIGN: National serial cross-sectional study. SETTING: Veterans Health Affairs inpatient and outpatient settings. PARTICIPANTS: Veterans aged 65 and older with PTSD (excluding schizophrenia or bipolar disorder) with or without concomitant dementia who received care from the Veterans Health Administration between 2003 and 2010 were identified using International Classification of Diseases, Ninth Revision, codes (N = 93,068; 11.1% with dementia). MEASUREMENTS: Trends in SGA prescribing and odds of being prescribed an SGA were determined using a multivariable logistic regression model adjusted for clinical, sociodemographic, and geographic covariates. RESULTS: Between 2004 and 2009, SGA prescribing declined annually from 7.0% to 5.1% of elderly veterans with PTSD without dementia and 13.2% to 8.9% in those with dementia; findings over time consistently indicated that veterans with PTSD and dementia had at least twice the odds of being prescribed an SGA as those without PTSD (odds ratios 2.03 (95% confidence interval (CI) = 1.82-2.26) to 2.33 (95% CI = 2.10-2.58). CONCLUSION: Although the prescribing of SGAs to elderly veterans with PTSD has decreased, prescribing an SGA to those with dementia remained consistently higher than for those with PTSD alone and is problematic given the high prevalence of medical comorbidities in this aging population coupled with the lack of compelling evidence for effectiveness of SGAs in individuals with dementia.
OBJECTIVES: To determine whether elderly veterans with posttraumatic stress disorder (PTSD) and dementia are more likely to be prescribed second-generation antipsychotics (SGAs) than those with PTSD alone. DESIGN: National serial cross-sectional study. SETTING: Veterans Health Affairs inpatient and outpatient settings. PARTICIPANTS: Veterans aged 65 and older with PTSD (excluding schizophrenia or bipolar disorder) with or without concomitant dementia who received care from the Veterans Health Administration between 2003 and 2010 were identified using International Classification of Diseases, Ninth Revision, codes (N = 93,068; 11.1% with dementia). MEASUREMENTS: Trends in SGA prescribing and odds of being prescribed an SGA were determined using a multivariable logistic regression model adjusted for clinical, sociodemographic, and geographic covariates. RESULTS: Between 2004 and 2009, SGA prescribing declined annually from 7.0% to 5.1% of elderly veterans with PTSD without dementia and 13.2% to 8.9% in those with dementia; findings over time consistently indicated that veterans with PTSD and dementia had at least twice the odds of being prescribed an SGA as those without PTSD (odds ratios 2.03 (95% confidence interval (CI) = 1.82-2.26) to 2.33 (95% CI = 2.10-2.58). CONCLUSION: Although the prescribing of SGAs to elderly veterans with PTSD has decreased, prescribing an SGA to those with dementia remained consistently higher than for those with PTSD alone and is problematic given the high prevalence of medical comorbidities in this aging population coupled with the lack of compelling evidence for effectiveness of SGAs in individuals with dementia.
Authors: Adam Sacarny; Michael L Barnett; Jackson Le; Frank Tetkoski; David Yokum; Shantanu Agrawal Journal: JAMA Psychiatry Date: 2018-10-01 Impact factor: 21.596
Authors: Kathleen E Bickel; Richard Kennedy; Cari Levy; Kathryn L Burgio; F Amos Bailey Journal: J Gen Intern Med Date: 2019-12-02 Impact factor: 5.128