Tendencias de prescripción y resultados asociados de los medicamentos antiepilépticos en hogares de ancianos de EE. UU. en torno a la pandemia de COVID-19
Tendencias de prescripción y resultados asociados de fármacos antiepilépticos y otros medicamentos psicoactivos en hogares de ancianos de EE. UU. en torno a la pandemia de COVID-19
Since the "National Partnership to Improve Dementia Care" debuted in 2012, almost all long-stay psychoactive prescribing has been graded by CMS, which has correlated to decreased use. However, some national data suggest that while these psychoactive medications are being used less, prescriptions of mood-stabilizing antiepileptic drugs (AEDs) have increased. Unlike all other psychoactive medications, AEDs prescribed in nursing homes are not mandatorily reported to CMS or graded in a quality-measure.
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Descripción detallada
Pilot studies from Virginia suggest increases in AEDs are concentrated entirely in dementia patients with no diagnosis of epilepsy and as a purposeful unmonitored alternative to antipsychotics. AEDs are not FDA approved for dementia symptoms, have weak efficacy evidence, and convey serious risk. Increasingly it seems likely that the Partnership's debut was an inflection point where the trend towards unmonitored alternative drugs for dementia symptoms sharply increased. Early Commonwealth data hints that the COVID pandemic represents a second critical point of inflection where the existing transition towards non-superior but unreported drugs is again rapidly accelerating. All outcomes associated with this evolving prescribing phenomenon remain unknown. That said, pilot data suggests that harms may be increasing without benefit, a development with relevance to all invested in improving dementia care including patients, caregivers, and policy makers.
Tipo de estudio
Inscripción (Estimado)
Contactos y Ubicaciones
Ubicaciones de estudio
-
-
Virginia
-
Richmond, Virginia, Estados Unidos, 23298
- Virginia Commonwealth University
-
-
Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
Acepta Voluntarios Saludables
Géneros elegibles para el estudio
Método de muestreo
Población de estudio
The study population will only include de-identified data sets that are eligible for download and analysis and that meet the inclusion and exclusion criteria. Only those 21 years or older will be included.
Descripción
Inclusion Criteria:
- All long-stay nursing home residents will be included. We define long-stay nursing home residents as all individuals residing in a nursing facility place of service for more than 100 days
- All nursing home clinicians prescribing psychoactive drugs will be included.
Exclusion Criteria:
- Limited to nursing home residents with continuous fee-for-service or Medicare Advantage plans as well as continuous Part D coverage.
- Residents without continuous fee-for-service insurance (less than 3 percent of nursing home population) will be excluded.
- Less than 0.2% of nursing home residents are children; still, this study will be restricted to those > 21 years of age.
- Nursing home residents who are discharged before the end of the quarterly study periods will also be excluded.
- Residents with discharges for acute hospitalizations followed by facility reentry on the same record will not be excluded.
- Non-prescribing clinicians and clinicians that do not prescribe psychoactive medications will be excluded.
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Modelos observacionales: COHORT
- Perspectivas temporales: OTHER
Cohortes e Intervenciones
Grupo / Cohorte |
Intervención / Tratamiento |
|---|---|
|
All nursing home residents included in the 2009-2021 MDS
All nursing home residents included in the 2009-2021 MDS |
This intervention requires the following procedures: Submitting data use agreement, MDS request defined and developed, Part D request, CMS public use file request defines and develop questionnaire Procedures include: Access VRDC for 2 years, Crosswalk CMS files and MDS using ID's, Preliminary analysis for validity/accuracy, Request revision/resubmission, Linked dataset created in VRDC and Distribute Questionnaire Procedures include: De-identified data securely stored, analysis, dissemination and knowledge translation |
|
Nursing home and non-nursing home residents diagnosed with an AD/ADRD condition
Nursing home and non-nursing home residents diagnosed with an AD/ADRD condition |
This intervention requires the following procedures: Submitting data use agreement, MDS request defined and developed, Part D request, CMS public use file request defines and develop questionnaire Procedures include: Access VRDC for 2 years, Crosswalk CMS files and MDS using ID's, Preliminary analysis for validity/accuracy, Request revision/resubmission, Linked dataset created in VRDC and Distribute Questionnaire Procedures include: De-identified data securely stored, analysis, dissemination and knowledge translation |
¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Quarterly rate of use and mean dose of AEDs in US nursing homes
Periodo de tiempo: The years 2009 to 2021
|
Quarterly rate of use and mean dose of AEDs in US nursing homes 2009-2021 |
The years 2009 to 2021
|
Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
|
Quarterly rate of use of AEDs in US nursing homes for long-stay residents
Periodo de tiempo: The years 2009 to 2012
|
Quarterly rate of use of AEDs in US nursing homes for long-stay residents with and without: dementia, seizure-epilepsy, psychiatric diagnoses, neuropathic pain, an appropriate diagnosis for AED use |
The years 2009 to 2012
|
|
Quarterly rate of adverse health events among US nursing home residents prescribed or not prescribed AEDs
Periodo de tiempo: The years 2009 to 2021
|
Quarterly rate of adverse health events among US nursing home residents prescribed or not prescribed AEDs from 2009 to 2021. Adverse health events include:
|
The years 2009 to 2021
|
Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Jonathan Winter, Virginia Commonwealth University
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Actual)
Finalización primaria (Estimado)
Finalización del estudio (Estimado)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Palabras clave
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- HM20025382
- R01AG074358 (Subvención/contrato del NIH de EE. UU.)
Información sobre medicamentos y dispositivos, documentos del estudio
Estudia un producto farmacéutico regulado por la FDA de EE. UU.
Estudia un producto de dispositivo regulado por la FDA de EE. UU.
Esta información se obtuvo directamente del sitio web clinicaltrials.gov sin cambios. Si tiene alguna solicitud para cambiar, eliminar o actualizar los detalles de su estudio, comuníquese con register@clinicaltrials.gov. Tan pronto como se implemente un cambio en clinicaltrials.gov, también se actualizará automáticamente en nuestro sitio web. .