Kali S Thomas1, Christopher J Wretman2, Philip D Sloane2, Paula Carder3, Lindsay Schwartz4, Anna S Beeber2, Sheryl Zimmerman2. 1. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA. Electronic address: Kali_Thomas@brown.edu. 2. The Cecil G. Sheps Center for Health Services Research; School of Social Work; University of North Carolina at Chapel Hill, NC, USA. 3. OHSU-PSU School of Public Health, Portland State University, Portland, OR, USA. 4. Center for Health Policy Evaluation in Long-Term Care; American Health Care Association/National Center for Assisted Living, Washington, DC, USA.
Abstract
OBJECTIVE: In nursing homes (NHs), psychoactive medication use has received notable attention, but less is known about prescribing in assisted living (AL). This study examined how antipsychotic and antianxiety medication prescribing in AL compares with NHs. DESIGN: Observational, cross-sectional AL data linked to publicly reported NH measures. SETTING AND PARTICIPANTS: Random sample of 250 AL communities and the full sample of 3371 NHs in 7 states. METHODS: We calculated the percentage of residents receiving antipsychotics and antianxiety medications. For each AL community, we calculated the distance to NHs in the state. Linear models estimated the relationship between AL prescribing and that of the closest and farthest 5 NHs, adjusting for AL characteristics and state fixed effects. RESULTS: The prescribing rate of potentially inappropriate antipsychotics (i.e., excluding for persons with recorded schizophrenia and Tourette syndrome) and of antianxiety medications (excluding for those on hospice) in AL was 15% and 21%, respectively. Unadjusted mean antipsychotic prescribing rates were nominally higher in AL than NHs (14.8% vs 14.6%; P = .056), whereas mean antianxiety prescribing was nominally lower in AL (21.2% vs 22.6%; P = .032). In adjusted analyses, AL rates of antipsychotic use were not associated with NH rates. However, being affiliated with an NH was associated with a lower rate of antipsychotic use [b = -0.03; 95% confidence interval (CI) -0.50 to -0.001; P = .043], whereas antianxiety rates were associated with neighboring NHs' prescribing rates (b = 0.43; 95% CI 0.16-0.70; P = .002). CONCLUSIONS AND IMPLICATIONS: This study suggests reducing antipsychotic medication use in NHs may influence AL practices in a way not accounted for by local NH patterns. And, because antianxiety medications have not been the focus of national campaigns, they may be more subject to local prescribing behaviors. It seems advantageous to consider prescribing in AL when efforts are implemented to change NH prescribing, as there seems to be related influence whether by affiliation or region. Published by Elsevier Inc.
OBJECTIVE: In nursing homes (NHs), psychoactive medication use has received notable attention, but less is known about prescribing in assisted living (AL). This study examined how antipsychotic and antianxiety medication prescribing in AL compares with NHs. DESIGN: Observational, cross-sectional AL data linked to publicly reported NH measures. SETTING AND PARTICIPANTS: Random sample of 250 AL communities and the full sample of 3371 NHs in 7 states. METHODS: We calculated the percentage of residents receiving antipsychotics and antianxiety medications. For each AL community, we calculated the distance to NHs in the state. Linear models estimated the relationship between AL prescribing and that of the closest and farthest 5 NHs, adjusting for AL characteristics and state fixed effects. RESULTS: The prescribing rate of potentially inappropriate antipsychotics (i.e., excluding for persons with recorded schizophrenia and Tourette syndrome) and of antianxiety medications (excluding for those on hospice) in AL was 15% and 21%, respectively. Unadjusted mean antipsychotic prescribing rates were nominally higher in AL than NHs (14.8% vs 14.6%; P = .056), whereas mean antianxiety prescribing was nominally lower in AL (21.2% vs 22.6%; P = .032). In adjusted analyses, AL rates of antipsychotic use were not associated with NH rates. However, being affiliated with an NH was associated with a lower rate of antipsychotic use [b = -0.03; 95% confidence interval (CI) -0.50 to -0.001; P = .043], whereas antianxiety rates were associated with neighboring NHs' prescribing rates (b = 0.43; 95% CI 0.16-0.70; P = .002). CONCLUSIONS AND IMPLICATIONS: This study suggests reducing antipsychotic medication use in NHs may influence AL practices in a way not accounted for by local NH patterns. And, because antianxiety medications have not been the focus of national campaigns, they may be more subject to local prescribing behaviors. It seems advantageous to consider prescribing in AL when efforts are implemented to change NH prescribing, as there seems to be related influence whether by affiliation or region. Published by Elsevier Inc.
Authors: Cassandra L Hua; Portia Y Cornell; Sheryl Zimmerman; Paula Carder; Kali S Thomas Journal: J Am Med Dir Assoc Date: 2022-08-08 Impact factor: 7.802
Authors: Sheryl Zimmerman; Philip D Sloane; Johanna Silbersack Hickey; Christopher J Wretman; Selen P Gizlice; Kali S Thomas; Paula Carder; John S Preisser Journal: J Am Geriatr Soc Date: 2022-06-14 Impact factor: 7.538