ABSTRACT

Objectives

Compare Virginia nursing homes in the top- and bottom-quintiles of antipsychotic use for variation in community, social, and facility factors.

Methods

2018 CMS data ascertained Virginia nursing homes in the top and bottom quintiles for antipsychotic use. The Virginia Health Department provided social determinant of health (SDOH) statistics for each facility’s county/city while claims identified facility demographics. Chi square and independent two-sample t-tests compared quintiles for regional, social, and demographic differences.

Results

Quintiles averaged 3000 residents and 56 facilities. Facilities with the lowest rates of antipsychotic use were more likely to be privately owned and had fewer African-American and minority residents and more white residents. All 18 SDOH statistics were superior for the communities of facilities with the lowest antipsychotic rates. Nine of these differences were statistically significant, including the aggregated “Health Opportunity Index.”

Conclusions

The antipsychotic prevalence rate for facilities in the top-quintile of antipsychotic use is fivefold the bottom-quintile’s rate. Antipsychotic prescribing in nursing homes is associated with regional, demographic, and social factors not addressed by existing antipsychotic reduction measures, with vulnerable populations at greatest risk.

Clinical Implications

The efficacy of measures aimed at curbing long-stay antipsychotic prescribing could be improved by addressing SDOH including economic opportunities.

中文翻译：

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社区、社会和设施因素和长期服用抗精神病药物

摘要

目标

比较弗吉尼亚疗养院在抗精神病药物使用方面处于前五分之一和后五分之一的情况，以了解社区、社会和设施因素的变化。

方法

2018 年 CMS 数据确定弗吉尼亚疗养院在抗精神病药物使用方面处于前五分之一和后五分之一。弗吉尼亚卫生部提供了每个设施所在县/市的健康社会决定因素 (SDOH) 统计数据，同时声明确定了设施人口统计数据。卡方检验和独立双样本t检验比较了五分位数的区域、社会和人口统计差异。

结果

昆泰平均有 3000 名居民和 56 个设施。抗精神病药物使用率最低的设施更有可能为私人所有，非裔美国人和少数族裔居民较少，白人居民较多。所有 18 项 SDOH 统计数据都优于抗精神病药率最低的设施社区。其中九个差异具有统计学意义，包括汇总的“健康机会指数”。

结论

抗精神病药使用前五分之一设施的抗精神病药流行率是后五分之一的五倍。疗养院中的抗精神病药物处方与区域、人口和社会因素相关，现有的抗精神病药物减少措施并未解决这些因素，而弱势人群面临的风险最大。

临床意义

通过解决包括经济机会在内的 SDOH，可以提高旨在遏制长期服用抗精神病药物处方的措施的有效性。