Objective:

The Veterans Health Administration (VHA) and the Centers for Medicare and Medicaid Services (CMS) each created initiatives to reduce off-label use of antipsychotics in patients with dementia in nursing homes. Although CMS has reported antipsychotic reductions, the impact on prescribing of antipsychotic and other CNS-active medications in the VHA remains unclear. The authors evaluated national trends in antipsychotic and other CNS-active medication prescribing for nursing home patients with dementia in the VHA.

Methods:

The study sample was all veterans with dementia residing in VHA nursing homes for more than 30 days (N=35,742). Using an interrupted time-series design, the quarterly prevalences of antipsychotic, antidepressant, antiepileptic, anxiolytic, opioid, and memory medication prescribing were evaluated from FY2009 through FY2018.

Results:

Antipsychotic prescribing in VHA nursing homes declined from FY2009 to FY2018 (from 33.7% to 27.5%), with similar declines in anxiolytic prescribing (from 33.5% to 27.1%). During this period, prescribing of antiepileptics, antidepressants, and opioids increased significantly (antiepileptics: from 26.8% to 43.3%; antidepressants: from 56.8% to 63.4%; opioids: from 32.6% to 41.2%). Gabapentin served as the main driver of antiepileptic increases (from 11.1% to 23.5%). Increases in antidepressant prescribing included sertraline, mirtazapine, and trazodone. From FY2009 to FY2018, the overall prescribing of non-antipsychotic psychotropic medications grew from 75.0% to 81.1%.

Conclusions:

Antipsychotic and anxiolytic prescribing for VHA nursing home residents with dementia declined, although overall prescribing of other psychotropic and opioid medications increased. Policies focused primarily on reducing antipsychotic use without considering use in the context of other medications may contribute to growth in alternative medication classes with even less evidence of benefit and similar risks.

中文翻译：

---

退伍军人健康管理局疗养院痴呆症患者抗精神病药减量效果评估

客观的：

退伍军人健康管理局 (VHA) 和医疗保险和医疗补助服务中心 (CMS) 各自制定了举措，以减少疗养院痴呆患者超说明书使用抗精神病药物。尽管 CMS 报告抗精神病药物减少，但对 VHA 中抗精神病药物和其他 CNS 活性药物处方的影响仍不清楚。作者评估了为 VHA 疗养院痴呆症患者开出的抗精神病药物和其他中枢神经系统活性药物的全国趋势。

方法：

研究样本是在 VHA 疗养院居住超过 30 天的所有患有痴呆症的退伍军人（N=35,742）。采用间断时间序列设计，评估了 2009 财年至 2018 财年抗精神病药、抗抑郁药、抗癫痫药、抗焦虑药、阿片类药物和记忆药物处方的季度流行率。

结果：

从 2009 财年到 2018 财年，VHA 疗养院的抗精神病药处方量有所下降（从 33.7% 降至 27.5%），抗焦虑药处方量也有类似下降（从 33.5% 降至 27.1%）。在此期间，抗癫痫药、抗抑郁药和阿片类药物的处方量显着增加（抗癫痫药：从26.8%增加到43.3%；抗抑郁药：从56.8%增加到63.4%；阿片类药物：从32.6%增加到41.2%）。加巴喷丁是抗癫痫药物增加的主要驱动力（从 11.1% 增加到 23.5%）。抗抑郁药处方的增加包括舍曲林、米氮平和曲唑酮。从2009财年到2018财年，非抗精神病精神药物的总体处方从75.0%增长到81.1%。

结论：

尽管其他精神药物和阿片类药物的总体处方量有所增加，但为患有痴呆症的 VHA 疗养院居民开出的抗精神病药和抗焦虑药处方有所减少。主要侧重于减少抗精神病药物使用而不考虑与其他药物一起使用的政策可能会促进替代药物类别的增长，而其益处和类似风险的证据甚至更少。