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Effect of hearing intervention on communicative function: A secondary analysis of the ACHIEVE randomized controlled trial 听力干预对交流功能的影响:ACHIEVE 随机对照试验的二次分析。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-12 DOI: 10.1111/jgs.19185
Victoria A. Sanchez AuD, PhD, Michelle L. Arnold AuD, PhD, Emmanuel E. Garcia Morales PhD, Nicholas S. Reed AuD, PhD, Sarah Faucette AuD, PhD, Sheila Burgard MS, Haley N. Calloway AuD, Josef Coresh MD, PhD, Jennifer A. Deal PhD, Adele M. Goman PhD, Lisa Gravens-Mueller MS, Kathleen M. Hayden PhD, Alison R. Huang PhD, Christine M. Mitchell ScM, Thomas H. Mosley Jr PhD, James S. Pankow PhD, James R. Pike MBA, Jennifer A. Schrack PhD, Laura Sherry AuD, Jacqueline M. Weycker AuD, Frank R. Lin MD, PhD, Theresa H. Chisolm PhD, For the ACHIEVE Collaborative Study

Background

The Aging and Cognitive Health Evaluation in Elders (ACHIEVE) Study was designed to determine the effects of a best-practice hearing intervention on cognitive decline among community-dwelling older adults. Here, we conducted a secondary analysis of the ACHIEVE Study to investigate the effect of hearing intervention on self-reported communicative function.

Methods

The ACHIEVE Study is a parallel-group, unmasked, randomized controlled trial of adults aged 70–84 years with untreated mild-to-moderate hearing loss and without substantial cognitive impairment. Participants were randomly assigned (1:1) to a hearing intervention (audiological counseling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed semiannually for 3 years. Self-reported communicative function was measured with the Hearing Handicap Inventory—Elderly Screening version (HHIE-S, range 0–40, higher scores indicate greater impairment). Effect of hearing intervention versus control on HHIE-S was analyzed through an intention-to-treat model controlling for known covariates.

Results

HHIE-S improved after 6-months with hearing intervention compared to control, and continued to be better through 3-year follow-up. We estimated a difference of −8.9 (95% CI: −10.4, −7.5) points between intervention and control groups in change in HHIE-S score from baseline to 6 months, −9.3 (95% CI: −10.8, −7.9) to Year 1, −8.4 (95% CI: −9.8, −6.9) to Year 2, and − 9.5 (95% CI: −11.0, −8.0) to Year 3. Other prespecified sensitivity analyses that varied analytical parameters did not change the observed results.

Conclusions

Hearing intervention improved self-reported communicative function compared to a control intervention within 6 months and with effects sustained through 3 years. These findings suggest that clinical recommendations for older adults with hearing loss should encourage hearing intervention that could benefit communicative function and potentially have positive downstream effects on other aspects of health.

背景老龄化与认知健康评估(ACHIEVE)研究旨在确定最佳听力干预对社区老年人认知能力下降的影响。在此,我们对 ACHIEVE 研究进行了二次分析,以调查听力干预对自我报告的交流功能的影响。方法ACHIEVE 研究是一项平行组、无掩蔽、随机对照试验,研究对象为 70-84 岁、患有轻度至中度听力损失且未接受治疗、无严重认知障碍的成年人。参与者被随机分配(1:1)到听力干预(听力咨询和提供助听器)或健康教育对照干预(由健康教育专家提供有关慢性疾病预防主题的个人课程)中,每半年进行一次跟踪,为期 3 年。听力障碍清单-老年人筛查版(HHIE-S,范围为 0-40,分数越高表示听力障碍越严重)对自我报告的交流功能进行了测量。通过意向治疗模型分析了听力干预与对照组相比对 HHIE-S 的影响,并控制了已知的协变量。结果与对照组相比,听力干预 6 个月后 HHIE-S 有所改善,并在 3 年的随访中持续改善。我们估计干预组和对照组的 HHIE-S 分数从基线到 6 个月的变化差异为 -8.9 (95% CI: -10.4, -7.5) 分,到第一年为 -9.3 (95% CI: -10.8, -7.9)分,到第二年为 -8.4 (95% CI: -9.8, -6.9)分,到第三年为 -9.5 (95% CI: -11.0, -8.0)分。结论与对照干预相比,听力干预能在 6 个月内改善自我报告的交流功能,且效果可持续 3 年。这些研究结果表明,针对听力损失老年人的临床建议应鼓励进行听力干预,这将有益于沟通功能,并可能对其他方面的健康产生积极的下游影响。
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引用次数: 0
Differences in opioid prescriptions by race among U.S. older adults with a hip fracture transitioning to community care 美国髋部骨折老年人过渡到社区护理时阿片类药物处方的种族差异
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-11 DOI: 10.1111/jgs.19160
Kaleen N. Hayes PharmD, PhD, Meghan A. Cupp MPH, Richa Joshi MSc, Melissa R. Riester PharmD, Francesca L. Beaudoin MD, PhD, Andrew R. Zullo PharmD, PhD

Background

Appropriate pain management can facilitate rehabilitation after a hip fracture as patients transition back to the community setting. Differences in opioid prescribing by race may exist during this critical transition period.

Methods

We conducted a retrospective cohort study of older adult U.S. Medicare beneficiaries with a hip fracture to examine whether the receipt and dose of opioids differs between Black and White patients as they transitioned back to the community setting. We stratified beneficiaries by whether they received institutional post-acute care (PAC). Outcomes were (1) receipt of an opioid and (2) opioid doses in the first 90 days in the community in milligram morphine equivalents (MMEs; also presented in mg oxycodone). We estimated relative rates and risk differences of opioid receipt and dose differences using Poisson and linear regression models, respectively, using the parametric g-formula to standardize for age and sex.

Results

We identified 164,170 older adults with hip fracture (mean age = 82.7 years; 75% female; 72% with PAC; 46% with opioid use after fracture). Overall use of opioids in the community was similar between Black and white beneficiaries. Black beneficiaries had lower average doses in their first 90 days in both total cumulative doses (PAC group: 165 [95% CI −264 to −69] fewer MMEs [−248 mg oxycodone]; no PAC: 167 [95% CI −274 to −62] fewer MMEs [−251 mg oxycodone]) and average MME per days' supply of medication (PAC: −3.0 [−4.6 to −1.4] fewer MMEs per day [−4.5 mg oxycodone]; no PAC: −4.7 [−4.6 to −1.4] fewer MMEs per day [−7.1 mg oxycodone]). In secondary analyses, Asian beneficiaries experienced the greatest differences (e.g., 617–653 fewer cumulative mg oxycodone).

Conclusion

Racial differences exist in pain management for Medicare beneficiaries after a hip fracture. Future work should examine whether these differences result in disparities in short- and long-term health outcomes.

背景髋部骨折后,当患者重返社区环境时,适当的疼痛管理可促进康复。我们对髋部骨折的美国老年医疗保险受益人进行了一项回顾性队列研究,以考察黑人和白人患者在重返社区的过程中接受阿片类药物治疗的情况和剂量是否存在差异。我们根据受益人是否接受机构性急性期后护理 (PAC) 对他们进行了分层。结果包括:(1)接受阿片类药物治疗;(2)在社区的前 90 天内阿片类药物的剂量(以毫克吗啡当量(MMEs)为单位;也以毫克羟考酮(mg oxycodone)为单位)。我们使用泊松模型和线性回归模型分别估算了接受阿片类药物的相对比率和风险差异以及剂量差异,并使用参数 g 公式对年龄和性别进行了标准化处理。结果我们确定了 164170 名髋部骨折的老年人(平均年龄 = 82.7 岁;75% 为女性;72% 患有 PAC;46% 在骨折后使用过阿片类药物)。黑人和白人受益人在社区使用阿片类药物的总体情况相似。黑人受益人在最初 90 天内的平均总累积剂量较低(PAC 组:165 [95% CI -0.5 -0.6减少 165 [95% CI -264 至 -69]个 MME [-248 毫克羟考酮];无 PAC 组:减少 167 [95% CI -264 至 -69] 个 MME [-248 毫克羟考酮]:167[95%CI-274至-62]次[-251毫克羟考酮])和每日均用药量(PAC:-每天减少 3.0 [-4.6 至 -1.4] 次[-4.5 毫克羟考酮];无 PAC:-无 PAC:每天减少 4.7 [-4.6 至 -1.4] 个 MME [-7.1 毫克羟考酮])。在二次分析中,亚裔受益人的差异最大(例如,累计减少 617-653 毫克羟考酮)。未来的工作应研究这些差异是否会导致短期和长期健康结果的差异。
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引用次数: 0
Recurrent pericarditis in older adults: Clinical and laboratory features and outcome 老年人复发性心包炎:临床和实验室特征及预后
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-09 DOI: 10.1111/jgs.19150
Emanuele Bizzi MD, Francesco Cavaleri MD, Ruggiero Mascolo MD, Edoardo Conte MD, Stefano Maggiolini MD, Caterina Chiara Decarlini MD, Silvia Maestroni MD, Valentino Collini MD, Ludovico Luca Sicignano MD, Elena Verrecchia MD, Raffaele Manna MD, Massimo Pancrazi MD, Lucia Trotta MD, Giuseppe Lopalco MD, Danilo Malandrino MD, Giada Pallini MD, Sara Catenazzi MD, Luisa Carrozzo MD, Giacomo Emmi MD, George Lazaros MD, Antonio Brucato MD, Massimo Imazio MD
<div> <section> <h3> Background</h3> <p>Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist.</p> </section> <section> <h3> Objective of the Study</h3> <p>Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis.</p> </section> <section> <h3> Materials and Methods</h3> <p>We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post-cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older.</p> </section> <section> <h3> Results</h3> <p>One hundred and thirty-three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (<i>p</i> < 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (<i>p</i> < 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (<i>p</i> = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, <i>p</i> < 0.001), as well as severe pericardial effusion (>20 mm) (24.1% vs 12.7%, <i>p</i> = 0.016) and pericardiocentesis (16.5% vs 8.5%, <i>p</i> = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm<sup>3</sup> vs 11,208 + 285/mm<sup>3</sup>, <i>p</i> = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (<i>p</i> = 0.003), colchicine in 76.7% versus 87.3% (<i>p</i> = 0.023), corticosteroids in 49.6% versus 26.8% (<i>p</i> < 0.001), and anakinra in 14.3% versus 23.9% (<i>p</i> = 0.044).</p> </section> <section> <h3> Conclusions</h3> <p>Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely d
背景:目前的心包炎诊断和治疗指南针对的是普通成年人。有关老年人复发性心包炎的数据极少且零散:鉴于科学文献中缺乏具体数据,我们假设特发性复发性心包炎患者中的年轻人和老年人在临床、实验室和治疗效果方面可能存在差异:我们进行了一项国际多中心回顾性队列研究,分析了受复发性心包炎(特发性或心脏损伤后)影响并转诊至三级转诊中心的患者的数据。对 65 岁以下患者(对照组)和 65 岁或以上患者的临床、实验室和结果数据进行了比较:结果:133 名老年人和 142 名年轻成人对照组参加了研究。老年人合并症较多,包括慢性肾病、心房颤动和糖尿病。出现呼吸困难症状的老年人占 54.1%,而对照组为 10.6%(P 20 毫米)(24.1% 对 12.7%,P = 0.016),出现心包穿刺症状的老年人占 16.5%,而对照组为 8.5%,P = 0.042)。老年人的血白细胞计数明显较低(平均值 + SE:10227 + 289/mm3 vs 11208 + 285/mm3,p = 0.016)。在治疗方法方面,63.9%的老年人使用非甾体抗炎药,而年轻人则为80.3%(P = 0.003);76.7%的老年人使用秋水仙碱,而年轻人则为87.3%(P = 0.023);49.6%的老年人使用皮质类固醇,而年轻人则为26.8%(P 结论:非甾体抗炎药和秋水仙碱在老年人中的使用率均高于年轻人:受复发性心包炎影响的老年人表现出不同的临床模式,更频繁地出现呼吸困难、胸腔积液、严重心包积液,发热更低,白细胞计数更低,因此诊断有时具有挑战性。他们接受非甾体抗炎药和秋水仙碱治疗的次数明显较少,这可能是由于合并症所致;他们接受抗IL1药物治疗的次数也较少,而接受皮质类固醇治疗的次数较多。
{"title":"Recurrent pericarditis in older adults: Clinical and laboratory features and outcome","authors":"Emanuele Bizzi MD,&nbsp;Francesco Cavaleri MD,&nbsp;Ruggiero Mascolo MD,&nbsp;Edoardo Conte MD,&nbsp;Stefano Maggiolini MD,&nbsp;Caterina Chiara Decarlini MD,&nbsp;Silvia Maestroni MD,&nbsp;Valentino Collini MD,&nbsp;Ludovico Luca Sicignano MD,&nbsp;Elena Verrecchia MD,&nbsp;Raffaele Manna MD,&nbsp;Massimo Pancrazi MD,&nbsp;Lucia Trotta MD,&nbsp;Giuseppe Lopalco MD,&nbsp;Danilo Malandrino MD,&nbsp;Giada Pallini MD,&nbsp;Sara Catenazzi MD,&nbsp;Luisa Carrozzo MD,&nbsp;Giacomo Emmi MD,&nbsp;George Lazaros MD,&nbsp;Antonio Brucato MD,&nbsp;Massimo Imazio MD","doi":"10.1111/jgs.19150","DOIUrl":"10.1111/jgs.19150","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective of the Study&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Materials and Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post-cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;One hundred and thirty-three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (&lt;i&gt;p&lt;/i&gt; &lt; 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (&lt;i&gt;p&lt;/i&gt; = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), as well as severe pericardial effusion (&gt;20 mm) (24.1% vs 12.7%, &lt;i&gt;p&lt;/i&gt; = 0.016) and pericardiocentesis (16.5% vs 8.5%, &lt;i&gt;p&lt;/i&gt; = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm&lt;sup&gt;3&lt;/sup&gt; vs 11,208 + 285/mm&lt;sup&gt;3&lt;/sup&gt;, &lt;i&gt;p&lt;/i&gt; = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (&lt;i&gt;p&lt;/i&gt; = 0.003), colchicine in 76.7% versus 87.3% (&lt;i&gt;p&lt;/i&gt; = 0.023), corticosteroids in 49.6% versus 26.8% (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), and anakinra in 14.3% versus 23.9% (&lt;i&gt;p&lt;/i&gt; = 0.044).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely d","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"72 11","pages":"3467-3475"},"PeriodicalIF":4.3,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Virtual reality-based cognitive exercise games in geriatric surgical patients: A pilot trial 老年外科手术患者的虚拟现实认知运动游戏:试点试验。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-06 DOI: 10.1111/jgs.19181
Hina Faisal MD, Faisal N. Masud MD, Kim Junhyoung PhD, Kenneth Podell PhD, Jiaqiong Xu PhD, Christina Boncyk MD, MPH, George E. Taffet MD, Malaz A. Boustani MD, MPH
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引用次数: 0
Association of nursing home antipsychotic reduction policies with antipsychotic use in community dwellers with dementia 疗养院减少使用抗精神病药物的政策与社区痴呆症患者使用抗精神病药物的关系。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-06 DOI: 10.1111/jgs.19184
Antoinette B. Coe PharmD, PhD, Tingting Zhang MD, PhD, Andrew R. Zullo PharmD, PhD, Lauren B. Gerlach DO, MS, Lori A. Daiello PharmD, ScM, Hiren Varma MS, Derrick Lo ScM, Richa Joshi MS, Julie P. W. Bynum MD, MPH, Theresa I. Shireman PhD

Background

Antipsychotic and other psychotropic medication use is prevalent among community-dwelling older adults with dementia despite the potential for adverse effects. Two Centers for Medicare & Medicaid Services (CMS) initiatives, the National Partnership to Improve Dementia Care (“the Partnership”) and the Five Star Quality Rating System for antipsychotic use reporting, have been successful in reducing antipsychotic use in nursing home residents. We assessed if these initiatives had a spillover effect in antipsychotic and other psychotropic medication use among community dwellers with dementia due to potential overlap in prescribers across settings.

Methods

Among community-dwelling older adults with dementia, we examined psychotropic medication class use (i.e., antipsychotics, antidepressants, anxiolytics, anticonvulsants/mood stabilizers, antidementia) in 2010–2017 Medicare fee-for-service claims using interrupted time series analyses across three periods (“Pre-Partnership”: July 1, 2010 to March 31, 2012; “Post-Partnership”: April 1, 2012 to January 31, 2015; “Five Star Quality Rating”: February 1, 2015 to December 31, 2017).

Results

We included 1,289,401 community dwellers with dementia contributing 26,609,697 person-months. The mean age was 80 years, most were female (70%), approximately 80% were non-Hispanic Whites, 10% were non-Hispanic Blacks, and 5% were Hispanic ethnicity. Antipsychotic use was declining pre-Partnership (β = −0.06, 95% CI: −0.08, −0.05) and post-Partnership (β = −0.02, 95% CI: −0.02, −0.01). Post-Five Star Quality Rating, antipsychotic use remained stable with a nearly flat slope (β = −0.01, 95% CI: −0.01, 0.00). Anticonvulsant and antidepressant use increased and anxiolytic and antidementia medication use decreased among community-dwelling older adults with dementia.

Conclusions

These two CMS policies on antipsychotic use for nursing home residents were not associated with a spillover effect to community-dwelling older adults with dementia. Strategies to monitor the appropriateness of psychotropic medication use may be warranted for community-dwellers with dementia.

背景:在社区居住的老年痴呆症患者中,抗精神病药物和其他精神药物的使用非常普遍,尽管这些药物可能会产生不良反应。美国联邦医疗保险与医疗补助服务中心(CMS)的两项举措--"改善痴呆症护理全国合作计划"(以下简称 "合作计划")和 "抗精神病药物使用报告五星质量评级系统"--成功地减少了疗养院居民的抗精神病药物使用。我们评估了这些措施是否会因处方者在不同环境中的潜在重叠而对患有痴呆症的社区居民使用抗精神病药和其他精神药物产生溢出效应:在患有痴呆症的社区居住老年人中,我们采用间断时间序列分析法研究了三个时期("合作前":2010 年 7 月 1 日至 2011 年 3 月 31 日;"合作后":2010 年 7 月 1 日至 2011 年 3 月 31 日;"合作前":2010 年 7 月 1 日至 2011 年 3 月 31 日)的 2010-2017 年医疗保险付费服务索赔中精神药物类别(即抗精神病药物、抗抑郁药物、抗焦虑药物、抗惊厥药物/情绪稳定剂、抗痴呆药物)的使用情况:合作前":2010 年 7 月 1 日至 2012 年 3 月 31 日;"合作后":2012 年 4 月 1 日至 2012 年 1 月 31 日:合作后":2012 年 4 月 1 日至 2015 年 1 月 31 日;"五星质量评级":2015 年 2 月 1 日至 12 月 31 日:结果:我们纳入了 1,289,401 名患有痴呆症的社区居民,共计 26,609,697 人月。平均年龄为 80 岁,大多数为女性(70%),约 80% 为非西班牙裔白人,10% 为非西班牙裔黑人,5% 为西班牙裔。合作前(β = -0.06,95% CI:-0.08,-0.05)和合作后(β = -0.02,95% CI:-0.02,-0.01),抗精神病药物的使用呈下降趋势。五星质量评级后,抗精神病药物的使用保持稳定,斜率几乎持平(β = -0.01,95% CI:-0.01,0.00)。在社区居住的老年痴呆症患者中,抗惊厥药和抗抑郁药的使用有所增加,抗焦虑药和抗痴呆药的使用有所减少:这两项 CMS 针对疗养院居民使用抗精神病药物的政策并未对社区居住的老年痴呆症患者产生溢出效应。对于社区居住的痴呆症患者来说,可能需要采取一些策略来监控精神药物使用的适当性。
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引用次数: 0
Applying difference-in-differences design in quality improvement and health systems research 在质量改进和卫生系统研究中应用差异设计。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-06 DOI: 10.1111/jgs.19180
Yucheng Hou PhD, MPP, Abdelaziz Alsharawy PhD
<p>Assessing the effectiveness of a health system intervention when randomized controlled trials (RCTs) are infeasible has long been a challenge for clinicians, health economists, and health service researchers alike. Difference-in-differences (DID) is a quasi-experimental study design that can be particularly appealing in addressing this challenge using observational data. Other nonexperimental study designs, such as regression adjustment or propensity score matching, attempt to examine the impact of an intervention by only accounting for the observed differences between groups. In contrast, an appropriately designed DID study aims to exploit randomness in intervention timing to identify the causal effects of the intervention. The number of published papers applying DID designs in the medical field has been increasing in recent years.<span><sup>1, 2</sup></span> Following this trend, the <i>Journal of the American Geriatrics Society</i> (JAGS) published 18 studies, mostly since 2018 (original data from the authors), that apply DID designs to examine a wide range of health system interventions that pertain to geriatrics care (Figure 1).</p><p>DID designs assess the effect of an intervention (e.g., health policy or program) applied to one or more groups (treated) by comparing their outcomes relative to a group that has never or not yet received the intervention (control) in terms of two differences.<span><sup>3, 4</sup></span> The first set of differences compares outcomes before and after the timing of the intervention for the treated and control groups, respectively. This process removes the observed and unobserved group-specific factors that do not change over time. Subtracting these differences (i.e., the second difference or difference-in-differences) removes the time-varying trends that are common to both groups. Together, DID identifies the causal effect of the intervention assuming that the treated would have experienced the same trend as the control group in the absence of the intervention (parallel trends).</p><p>In the recent issue of JAGS, a study by Burke and colleagues<span><sup>5</sup></span> used a DID design to evaluate changes in patient care outcomes following the Age-Friendly health systems recognition in the Veterans Health Administration. The authors incorporated recent advances in DID with staggered treatment timing developed by Sun and Abraham,<span><sup>6</sup></span> which is appropriate as the receipt of recognition across the medical sites happened at different times. This approach addresses potential biases in traditional DID estimation—often referred to as two-way fixed effects—when treatment effects are not constant over time and differ by late versus early treated sites.<span><sup>6-8</sup></span> Given the absence of an RCT in this setting, one of the notable strengths of this study stems from using observational data to measure the effect of recognition for implementing evidence-based care transformations (4Ms: wh
{"title":"Applying difference-in-differences design in quality improvement and health systems research","authors":"Yucheng Hou PhD, MPP,&nbsp;Abdelaziz Alsharawy PhD","doi":"10.1111/jgs.19180","DOIUrl":"10.1111/jgs.19180","url":null,"abstract":"&lt;p&gt;Assessing the effectiveness of a health system intervention when randomized controlled trials (RCTs) are infeasible has long been a challenge for clinicians, health economists, and health service researchers alike. Difference-in-differences (DID) is a quasi-experimental study design that can be particularly appealing in addressing this challenge using observational data. Other nonexperimental study designs, such as regression adjustment or propensity score matching, attempt to examine the impact of an intervention by only accounting for the observed differences between groups. In contrast, an appropriately designed DID study aims to exploit randomness in intervention timing to identify the causal effects of the intervention. The number of published papers applying DID designs in the medical field has been increasing in recent years.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Following this trend, the &lt;i&gt;Journal of the American Geriatrics Society&lt;/i&gt; (JAGS) published 18 studies, mostly since 2018 (original data from the authors), that apply DID designs to examine a wide range of health system interventions that pertain to geriatrics care (Figure 1).&lt;/p&gt;&lt;p&gt;DID designs assess the effect of an intervention (e.g., health policy or program) applied to one or more groups (treated) by comparing their outcomes relative to a group that has never or not yet received the intervention (control) in terms of two differences.&lt;span&gt;&lt;sup&gt;3, 4&lt;/sup&gt;&lt;/span&gt; The first set of differences compares outcomes before and after the timing of the intervention for the treated and control groups, respectively. This process removes the observed and unobserved group-specific factors that do not change over time. Subtracting these differences (i.e., the second difference or difference-in-differences) removes the time-varying trends that are common to both groups. Together, DID identifies the causal effect of the intervention assuming that the treated would have experienced the same trend as the control group in the absence of the intervention (parallel trends).&lt;/p&gt;&lt;p&gt;In the recent issue of JAGS, a study by Burke and colleagues&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; used a DID design to evaluate changes in patient care outcomes following the Age-Friendly health systems recognition in the Veterans Health Administration. The authors incorporated recent advances in DID with staggered treatment timing developed by Sun and Abraham,&lt;span&gt;&lt;sup&gt;6&lt;/sup&gt;&lt;/span&gt; which is appropriate as the receipt of recognition across the medical sites happened at different times. This approach addresses potential biases in traditional DID estimation—often referred to as two-way fixed effects—when treatment effects are not constant over time and differ by late versus early treated sites.&lt;span&gt;&lt;sup&gt;6-8&lt;/sup&gt;&lt;/span&gt; Given the absence of an RCT in this setting, one of the notable strengths of this study stems from using observational data to measure the effect of recognition for implementing evidence-based care transformations (4Ms: wh","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 1","pages":"8-11"},"PeriodicalIF":4.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Telehealth availability and use among beneficiaries in Traditional Medicare and Medicare Advantage 传统医疗保险和医疗保险优势计划受益人的远程医疗可用性和使用情况。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-06 DOI: 10.1111/jgs.19183
Sungchul Park PhD, Hye-Young Jung PhD, Jiani Yu PhD

Background

Medicare Advantage (MA) plans must cover all telehealth services offered by Traditional Medicare (TM), but have flexibility to provide additional telehealth services. It is not known whether these flexibilities are associated with telehealth availability and use. In this study, we examined differences in telehealth availability and use between TM and MA beneficiaries.

Methods

This cross-sectional study analyzed beneficiaries who participated in the 2021 Medicare Current Beneficiary Survey. Our primary outcomes were telehealth availability and use, assessed both overall and by modality (telephone only, video only, and both). Our key independent variable was full-year enrollment in MA versus TM. Differences in outcomes between TM and MA beneficiaries were estimated using logistic regression models that adjusted for beneficiary characteristics. The analysis of telehealth availability included all beneficiaries in the sample, while the analysis of telehealth use was limited to those offered telehealth services. In a secondary analysis, we examined differences between TM and MA beneficiaries in the availability of technology that may enable telehealth use and experience using the internet to seek information.

Results

Among 8130 Medicare beneficiaries, MA beneficiaries were 2.9 (95% CI: 0.6–5.2) percentage points more likely to have a provider who offered telehealth services than TM beneficiaries, including both telephone and video options. However, MA beneficiaries were 3.5 (−6.7, −0.4) percentage points less likely to use telehealth services than TM beneficiaries. Video-only options were used less frequently among MA beneficiaries compared to those in TM (−2.7 [−5.1, −0.3]). Despite lower telehealth use, MA beneficiaries had comparable or higher rates of technology access and internet experience compared to TM beneficiaries.

Conclusion

Our findings suggest that greater access to telehealth services among MA beneficiaries did not translate into greater telehealth use. Future research is warranted to explore the underlying mechanisms behind lower use of telehealth services among MA beneficiaries.

背景:医疗保险优势计划(MA)必须涵盖传统医疗保险(TM)提供的所有远程医疗服务,但可以灵活提供额外的远程医疗服务。目前尚不清楚这些灵活性是否与远程医疗的可用性和使用相关。在本研究中,我们考察了 TM 和 MA 受益人在远程医疗可用性和使用方面的差异:这项横断面研究分析了参与 2021 年医疗保险当前受益人调查的受益人。我们的主要结果是远程医疗的可用性和使用情况,按总体和方式(仅电话、仅视频和两者)进行评估。我们的关键自变量是医疗保险与远程医疗的全年注册情况。使用调整了受益人特征的逻辑回归模型估算了 TM 受益人与 MA 受益人之间的结果差异。对远程医疗可用性的分析包括样本中的所有受益人,而对远程医疗使用情况的分析则仅限于提供远程医疗服务的受益人。在一项辅助分析中,我们研究了 TM 受益人和医疗保险受益人在远程医疗技术可用性方面的差异,以及使用互联网寻求信息的经验:在 8130 名医疗保险受益人中,医疗保险受益人拥有提供远程医疗服务的医疗服务提供者(包括电话和视频选项)的可能性比传统医疗受益人高 2.9 个百分点(95% CI:0.6-5.2)。然而,医疗保险受益人使用远程医疗服务的可能性比传统医疗受益人低 3.5 (-6.7, -0.4)个百分点。与 TM 受益人相比,MA 受益人使用纯视频选项的频率较低(-2.7 [-5.1, -0.3])。尽管远程医疗的使用率较低,但与 TM 受益人相比,MA 受益人的技术使用率和互联网经验相当或更高:我们的研究结果表明,医疗保险受益人获得远程医疗服务的机会越多,远程医疗的使用率就越高。未来有必要开展研究,探索医疗保险受益人远程医疗服务使用率较低的根本原因。
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引用次数: 0
Supporting meaningful participation of older people in core outcome set development 支持老年人有意义地参与核心成果集的制定。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-06 DOI: 10.1111/jgs.19179
Jacqueline Martin-Kerry BAppSci(Hons) PhD, Sion Scott MPharm PhD, Jo Taylor BA (Hons) MRes PhD, David Wright BPharm (Hons) PGCHE PhD, Martyn Patel BMBCh MA, Jennie Griffiths, Victoria L. Keevil PhD BMBCh, Miles D. Witham BM BCh PhD, Allan Clark BSc(Hons) PhD, Ian Kellar PhD, David Turner BSc (Economics) MSc, Debi Bhattacharya BPharm PhD
<p>The use of core outcome sets (COS) by trials is widely accepted as best practice, aiming to improve research efficiency by enabling comparison and aggregation of results across trials for specific clinical areas.<span><sup>1</sup></span> A COS is an agreed minimum set of standardized outcomes that should be reported in all trials for a specific clinical area.<span><sup>1</sup></span> A COS should include only fundamental outcomes, that is, <i>core</i> to evaluating a treatment or intervention, rather than every relevant or important outcome.<span><sup>1, 2</sup></span> Trials can additionally measure other outcomes.<span><sup>1, 3</sup></span></p><p>Outcomes in a COS should be valid and important for all stakeholders. When developing a COS for hospital deprescribing trials,<span><sup>4</sup></span> we involved stakeholders that would be affected by the intervention: older patients and their carers; healthcare professionals who care for older people in hospital; hospital managers; and academics researching older people's medicine/deprescribing. We followed COMET (Core Outcome Measures in Effectiveness Trials) guidance for COS development<span><sup>1</sup></span>; this summarizes available methods for COS development but provides limited guidance on how to ensure meaningful involvement of patients, who historically have not been involved in deciding which outcomes should be measured in trials. The INCLUDE framework highlights that older people are often explicitly or implicitly excluded from healthcare research.<span><sup>5</sup></span> Despite anticipating some barriers to older people's participation in our COS study and addressing these in the study planning, we experienced several challenges to ensuring that the selection of outcomes for the COS included their views. We reflect on these challenges, discuss what worked to address them, and present further refinements that could better support equitable, meaningful participation of older people in COS development. <b>Study registration:</b> COMET (Core Outcome Measures in Effectiveness Trials) database (https://www.comet-initiative.org/Studies/Details/1825).</p><p>Developing a COS generally begins with generating a long list (10–100 s) of potentially relevant outcomes for participants to rate.<span><sup>1</sup></span> Although a range of techniques exist for approaching consensus, Delphi surveys dominate the literature regardless of the target population and clinical area.<span><sup>1, 6, 7</sup></span> Guidance states that during the Delphi, participants should consider each outcome individually, without comparing with other outcomes. We presented 49 outcomes (with plain English definitions) in the first Delphi round for participants to rate in terms of their importance to measure in hospital deprescribing trials. We grouped similar outcomes together and provided instructions informed by our Patient and Public Involvement (PPI) members, about how to review each outcome. Despite these strategi
{"title":"Supporting meaningful participation of older people in core outcome set development","authors":"Jacqueline Martin-Kerry BAppSci(Hons) PhD,&nbsp;Sion Scott MPharm PhD,&nbsp;Jo Taylor BA (Hons) MRes PhD,&nbsp;David Wright BPharm (Hons) PGCHE PhD,&nbsp;Martyn Patel BMBCh MA,&nbsp;Jennie Griffiths,&nbsp;Victoria L. Keevil PhD BMBCh,&nbsp;Miles D. Witham BM BCh PhD,&nbsp;Allan Clark BSc(Hons) PhD,&nbsp;Ian Kellar PhD,&nbsp;David Turner BSc (Economics) MSc,&nbsp;Debi Bhattacharya BPharm PhD","doi":"10.1111/jgs.19179","DOIUrl":"10.1111/jgs.19179","url":null,"abstract":"&lt;p&gt;The use of core outcome sets (COS) by trials is widely accepted as best practice, aiming to improve research efficiency by enabling comparison and aggregation of results across trials for specific clinical areas.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; A COS is an agreed minimum set of standardized outcomes that should be reported in all trials for a specific clinical area.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; A COS should include only fundamental outcomes, that is, &lt;i&gt;core&lt;/i&gt; to evaluating a treatment or intervention, rather than every relevant or important outcome.&lt;span&gt;&lt;sup&gt;1, 2&lt;/sup&gt;&lt;/span&gt; Trials can additionally measure other outcomes.&lt;span&gt;&lt;sup&gt;1, 3&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;Outcomes in a COS should be valid and important for all stakeholders. When developing a COS for hospital deprescribing trials,&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; we involved stakeholders that would be affected by the intervention: older patients and their carers; healthcare professionals who care for older people in hospital; hospital managers; and academics researching older people's medicine/deprescribing. We followed COMET (Core Outcome Measures in Effectiveness Trials) guidance for COS development&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt;; this summarizes available methods for COS development but provides limited guidance on how to ensure meaningful involvement of patients, who historically have not been involved in deciding which outcomes should be measured in trials. The INCLUDE framework highlights that older people are often explicitly or implicitly excluded from healthcare research.&lt;span&gt;&lt;sup&gt;5&lt;/sup&gt;&lt;/span&gt; Despite anticipating some barriers to older people's participation in our COS study and addressing these in the study planning, we experienced several challenges to ensuring that the selection of outcomes for the COS included their views. We reflect on these challenges, discuss what worked to address them, and present further refinements that could better support equitable, meaningful participation of older people in COS development. &lt;b&gt;Study registration:&lt;/b&gt; COMET (Core Outcome Measures in Effectiveness Trials) database (https://www.comet-initiative.org/Studies/Details/1825).&lt;/p&gt;&lt;p&gt;Developing a COS generally begins with generating a long list (10–100 s) of potentially relevant outcomes for participants to rate.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Although a range of techniques exist for approaching consensus, Delphi surveys dominate the literature regardless of the target population and clinical area.&lt;span&gt;&lt;sup&gt;1, 6, 7&lt;/sup&gt;&lt;/span&gt; Guidance states that during the Delphi, participants should consider each outcome individually, without comparing with other outcomes. We presented 49 outcomes (with plain English definitions) in the first Delphi round for participants to rate in terms of their importance to measure in hospital deprescribing trials. We grouped similar outcomes together and provided instructions informed by our Patient and Public Involvement (PPI) members, about how to review each outcome. Despite these strategi","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"73 2","pages":"661-665"},"PeriodicalIF":4.3,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jgs.19179","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comment on: Hyponatremia–associated hospital visits are not reduced by early electrolyte testing in older adults starting antidepressants 发表评论:对开始服用抗抑郁药的老年人进行早期电解质检测并不能减少与低钠血症相关的住院治疗。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-05 DOI: 10.1111/jgs.19165
Ilyas Akkar MD, Zeynep Iclal Turgut MD, Mustafa Hakan Dogan MD, Muhammet Cemal Kizilarslanoglu MD
<p>We read the article by Lane et al.<span><sup>1</sup></span> with great interest. They demonstrated that the early testing rate of serum sodium levels and the need for hospitalization due to hyponatremia were lower than expected in the study population that started on antidepressant therapy. In support of these findings, it was speculated by the authors that early sodium testing in all patients with antidepressant treatment may not be clinically beneficial. Although the study has a suitable methodology and an excellent presentation, further prospectively designed studies are warranted to test these hypotheses investigated in the recent study before changing routine clinical practice. We know that hyponatremia is a significant cause of morbidity and even mortality in this older patient population.<span><sup>2</sup></span> Current guidelines emphasize the importance of close follow-up of the patients by measuring their serum sodium levels, especially in older people who have newly started antidepressants because antidepressant-associated hyponatremia is usually observed within the first weeks after initiation of the treatment.<span><sup>3</sup></span></p><p>Moreover, it has been emphasized that sodium monitoring should not be forgotten after the initiation of antidepressant treatments, especially in older individuals who are concomitantly using drugs such as diuretics that may decrease serum sodium levels.<span><sup>4</sup></span> Supportingly, the recent study observed that the most common underlying comorbidities in patients requiring hospitalization due to hyponatremia were heart failure and urinary tract infection. Therefore, sodium monitoring should be kept in mind when evaluating patients who have additional conditions that may increase the risk of hyponatremia and started antidepressant therapy.</p><p>Another critical point taken from the recent study is the exclusion from the study of about four thousand patients who died during the follow-up period after antidepressant treatment initiation. If most of these excluded patients were in the group without monitoring serum sodium levels, this may cause a selection bias in the study. Therefore, if the data of these deceased patients can be accessed in detail and included in the analyses, it may strengthen the study's results. Alternatively, there are conflicting data in the literature regarding the cutoff point of serum sodium levels in patients using antidepressants to predict symptomatic hyponatremia.<span><sup>5</sup></span> The recent study reported that the median serum sodium value of patients requiring hospitalization was 132 mmol/L. However, we could not find any clear information about whether these hospital admissions were due to symptomatic hyponatremia or not. Therefore, some reasons for admission or symptoms in the study population may have derived from another clinical condition other than hyponatremia. A detailed examination of the symptoms in the hospitalized group may strengthe
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引用次数: 0
The cost of potentially inappropriate medications for older adults in Canada: A comparative cross-sectional study 加拿大老年人潜在不当用药的成本:横断面比较研究。
IF 4.3 2区 医学 Q1 GERIATRICS & GERONTOLOGY Pub Date : 2024-09-05 DOI: 10.1111/jgs.19164
Jean-François Huon PharmD, PhD, Chiranjeev Sanyal PhD, Camille L. Gagnon PharmD, MSc, Justin P. Turner PhD, Ninh B. Khuong MSc, Émilie Bortolussi-Courval RN, PhD Student, Todd C. Lee MD, MPH, James L. Silvius MD, Steven G. Morgan PhD, Emily G. McDonald MD, MSc

Background

Potentially inappropriate medications (PIMs) are medications whereby the harms may outweigh the benefits for a given individual. Although overprescribed to older adults, their direct costs on the healthcare system are poorly described.

Methods

This was a cross-sectional study of the cost of PIMs for Canadians aged 65 and older, using adapted criteria from the American Geriatrics Society. We examined prescription claims information from the National Prescription Drug Utilization Information System in 2021 and compared these with 2013. The overall levels of inflation-adjusted total annual expenditure on PIMs, average cost per quarterly exposure, and average quarterly exposures to PIMs were calculated in CAD$.

Results

Exposure to most categories of PIMs decreased, aside from gabapentinoids, proton pump inhibitors, and antipsychotics, all of which increased. Canadians spent $1 billion on PIMs in 2021, a 33.6% reduction compared with 2013 ($1.5 billion). In 2021, the largest annual expenditures were on proton pump inhibitors ($211 million) and gabapentinoids ($126 million). The quarterly amount spent on PIMs per person exposed decreased from $95 to $57. In terms of mean cost per person, opioids and antipsychotics were highest ($138 and $118 per exposure). Some cost savings may have occurred secondary to an observed decline of 16.4% in the quarterly rate of exposure to PIMs (from 7301 per 10,000 in 2013 to 6106 per 10,000 in 2021).

Conclusions

While expenditures on PIMs have declined in Canada, the overall cost remains high. Prescribing of some seriously harmful classes of PIMs has increased and so directed, scalable interventions are needed.

背景:潜在不适当药物(PIMs)是指对特定个体而言弊大于利的药物。虽然老年人用药过多,但其对医疗系统造成的直接成本却很少被描述:这是一项关于 65 岁及以上加拿大人 PIMs 成本的横断面研究,采用的是美国老年医学会改编的标准。我们研究了 2021 年国家处方药使用信息系统(National Prescription Drug Utilization Information System)中的处方报销信息,并将其与 2013 年进行了比较。我们以加元为单位计算了经通胀调整后的 PIMs 年度总支出水平、每季度接触 PIMs 的平均成本以及每季度接触 PIMs 的平均次数:除了加巴喷丁类药物、质子泵抑制剂和抗精神病药物的使用量有所上升外,大多数类别的 PIMs 使用量都有所下降。2021 年加拿大人在 PIMs 上的花费为 10 亿美元,与 2013 年(15 亿美元)相比减少了 33.6%。2021 年,质子泵抑制剂(2.11 亿美元)和加巴喷丁类药物(1.26 亿美元)的年度支出最大。就人均成本而言,阿片类药物和抗精神病药物的人均成本最高(每次暴露 138 美元和 118 美元)。据观察,每季度接触 PIMs 的比例下降了 16.4%(从 2013 年的每 10,000 人 7301 例降至 2021 年的每 10,000 人 6106 例),因此可能节省了一些成本:虽然加拿大的 PIMs 支出有所下降,但总体成本仍然很高。一些严重有害的PIMs类药物的处方量有所增加,因此需要采取定向、可扩展的干预措施。
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Journal of the American Geriatrics Society
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