National surveillance using a clinical quality indicator for prolonged antipsychotic use among older Australians with dementia who access aged care services

Author:

Sluggett Janet K.12ORCID,Caughey Gillian E.12,Air Tracy2,Cations Monica23ORCID,Lang Catherine E.2,Ward Stephanie A.456,Ahern Susannah6,Lin Xiaoping6,Wallis Kasey6,Crotty Maria78,Inacio Maria C.12

Affiliation:

1. University of South Australia UniSA Allied Health and Human Performance Adelaide South Australia Australia

2. Registry of Senior Australians (ROSA) South Australian Health and Medical Research Institute Adelaide South Australia Australia

3. College of Education Psychology and Social Work Flinders University Adelaide South Australia Australia

4. Centre for Healthy Brain Ageing School of Psychiatry University of New South Wales Sydney New South Wales Australia

5. Department of Geriatric Medicine The Prince of Wales Hospital Randwick New South Wales Australia

6. School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia

7. Southern Adelaide Local Health Network SA Health Adelaide South Australia Australia

8. College of Medicine and Public Health Flinders University Adelaide South Australia Australia

Abstract

AbstractObjectivesDementia guidelines recommend antipsychotics are only used for behavioral and psychological symptoms when non‐drug interventions fail, and to regularly review use. Population‐level clinical quality indicators (CQIs) for dementia care in permanent residential aged care (PRAC) typically monitor prevalence of antipsychotic use but not prolonged use. This study aimed to develop a CQI for antipsychotic use >90 days and examine trends, associated factors, and variation in CQI incidence; and examine duration of the first episode of use among individuals with dementia accessing home care packages (HCPs) or PRAC.MethodsRetrospective cohort study, including older individuals with dementia who accessed HCPs (n = 50,257) or PRAC (n = 250,196). Trends in annual CQI incidence (2011–12 to 2015–16) and associated factors were determined using Poisson regression. Funnel plots examined geographical and facility variation. Time to antipsychotic discontinuation was estimated among new antipsychotic users accessing HCP (n = 2367) and PRAC (n = 15,597) using the cumulative incidence function.ResultsBetween 2011–12 and 2015–16, antipsychotic use for >90 days decreased in HCP recipients from 10.7% (95% CI 10.2–11.1) to 10.1% (95% CI 9.6–10.5, adjusted incidence rate ratio (aIRR) 0.97 (95% CI 0.95–0.98)), and in PRAC residents from 24.5% (95% CI 24.2–24.7) to 21.8% (95% CI 21.5–22.0, aIRR 0.97 (95% CI 0.96–0.98)). Prior antipsychotic use (both cohorts) and being male and greater socioeconomic disadvantage (PRAC cohort) were associated with higher CQI incidence. Little geographical/facility variation was observed. Median treatment duration in HCP and PRAC was 334 (interquartile range [IQR] 108–958) and 555 (IQR 197–1239) days, respectively.ConclusionsWhile small decreases in antipsychotic use >90 days were observed between 2011–12 and 2015–16, findings suggest antipsychotic use among aged care recipients with dementia can be further minimized.

Funder

National Health and Medical Research Council

Hospital Research Foundation

Publisher

Wiley

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