- Email: [email protected]
Concomitant use of psychotropic drugs in patients with dementia
P588
P2-251
Poster Presentations: P2
COGNITIVE IMPAIRMENT IN PRIMARY CARE: PRACTICE PATTERNS AND ATTITUDES COMPARED TO NEUROLOGY
Lealani Mae Acosta, Raymond Romano, Angela L. Jefferson, Vanderbilt University, Nashville, TN, USA. Contact e-mail: lealani.mae.acosta@ vanderbilt.edu Background: Neurologists’ practice patterns and attitudes regarding diagnosing and treating mild cognitive impairment (MCI) have been explored previously (Roberts et al., 2010), but similar data about primary care provider (PCP) practice patterns and attitudes have not been reported. Because neurologists primarily receive referrals from PCPs, there is a need to assess how PCPs approach diagnosis, treatment, and specialty referrals of patients with MCI to determine any differences in practice patterns, including how to address such differences. We hypothesized that PCPs would vary from neurologists regarding both attitudes towards and treatment of MCI. Methods:
A survey (in both email and postal mail format) was distributed to 1274 PCPs (physicians 80%, physician assistants 20%) in the greater Nashville area. The survey included portions of the survey originally sent to neurologists in the Roberts et al., 2010 study (e.g., counseling and attitudes towards MCI) and original questions about referral practices (e.g., different clinical vignettes prompting referrals). Results: Our survey response rate was low (6.6%) compared to the Roberts et al., 2010 survey (48%). When comparing responses to questions administered in both surveys, Fisher’s exact test results suggested neurologists and PCPs have strikingly similar attitudes about the benefits and drawbacks of making the diagnosis of MCI (all p-values >0.09). Conversely, out of 13 counseling practices (e.g., support services, diet/nutrition), the PCPs differed from neurologists on 12 of these items (p<0.05), ranging from prescribing medication to counseling about other aspects of health. The only different counseling practice was providing a written summary to the patient, which just missed the a priori threshold for significance (p¼0.06). Conclusions: MCI may serve as a key point of intervention to delay progression to dementia, so early identification and treatment of these patients is crucial. These survey results demonstrate a disparity between PCPs and neurologists regarding how best to care for MCI patients, a finding that needs to be addressed to provide optimal care to this growing patient population, including appropriate referral for a more specialized memory loss work-up.
P2-252
CONCOMITANT USE OF PSYCHOTROPIC DRUGS IN PATIENTS WITH DEMENTIA
Ane Nørgaard1, Christina Jensen-Dahm1, Christiane Gasse2, Gunhild Waldemar3, 1Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark; 2National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; 3Danish Dementia Research Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Contact e-mail: [email protected] Background: Antipsychotic drugs and other psychotropic drugs are frequently used to treat neuropsychiatric symptoms (NPS) in patients with dementia, even though the evidence for effect is limited. Patients with dementia are at increased risk of serious adverse events when treated with psychotropic drugs and the drugs should be used with caution. The extent of concomitant use of antipsychotic, anxiolytic, hypnotic/sedative and antidepressant drugs is unknown. Therefore, we aimed to investigate the prevalence and predictors of concomitant use of psychotropic drugs in patients with dementia in Denmark. Methods: Based on data from nationwide registers we included all patients with dementia (age65)
on January 1, 2012. We obtained information about redeemed prescriptions, demographics and somatic and psychiatric comorbidity. The treatment duration of all psychotropic prescriptions was calculated from the number of defined daily doses (DDD). Prescriptions with overlapping treatment periods were used to identify patients using more than one psychotropic drug concomitantly. Results: On January 1, 2012 we identified 34,553 patients with dementia (3.5%) among the 974,431 Danish residents aged 65. In 2012 concomitant use of 2 psychotropic drugs occurred in 25.3% of patients with dementia. 76.7% of patients with dementia using antipsychotics (N¼7043) received at least one other psychotropic drug concomitantly. The most frequent combination of psychotropic drugs was antipsychotic and antidepressant drugs and 68.4% of patients with dementia using antipsychotics received antidepressants concomitantly. Among nursing home residents with dementia (N¼17,080) 30.9% used 2 psychotropic drugs concomitantly and 71.0% of antipsychotic drug users (N¼4533) received antidepressants concomitantly. Conclusions: Concomitant use of psychotropic drugs was common in patients with dementia. Concomitant use of antipsychotics and antidepressants was the most frequent combination. Both drug classes have been associated with increased risk of serious adverse events and death, and it is unknown whether concomitant use is associated with an increased risk.
P2-253
PERFORMANCE ON COGNITIVE SCREENING IS ASSOCIATED WITH INCREASED RETROSPECTIVE HEALTHCARE UTILIZATION
Leah R. Hanson1,2, Terry R. Barclay1,2, Ann Hanson2, Logan Stuck2, Jean Crow1,2, Soo Borson3, Michael H. Rosenbloom1,2, 1HealthPartners Center for Memory and Aging, St. Paul, MN, USA; 2HealthPartners Institute for Education and Research, Bloomington, MN, USA; 3University of Washington, Seattle, WA, USA. Contact e-mail: leah.r.hanson@ healthpartners.com Background: Much dementia is not identified in health care environments until the moderate-severe stages. Screening for cognitive impairment can substantially improve detection, but has not been widely implemented in health care systems to date. HealthPartners has piloted the use of the Mini-Cog as a standardized screening tool for cognitive impairment in patients aged 65 and older to help establish a framework for promoting systematic outcomes research on patients with previously undetected cognitive impairment. In this preliminary study, we tested potential correlates of cognitive impairment in individuals who were later screened with the Mini-Cog, examining pre-screening indicators of chronic disease management and health care utilization. Methods: Patients screened within specialty or primary care clinics were identified. Data from the 18 months prior to screening were collected from the electronic medical record and included the Mini-Cog score (scored 0-5, a positive screen defined for this study as <4), demographics, diagnosis of three chronic conditions (diabetes, hypertension, hyperlipidemia), standard measures of control (HbA1c, blood pressure, lipid panel), and measures of healthcare utilization in a subset of patients (n¼819) with claims information. Data analysis consisted of Poisson regression and mixed effects regression. Results: The Mini-Cog was administered to 1,124 patients (average 77 yr, 58% female) and 32% screened positive. No significant differences in pre-screening measures of chronic disease control were found for those screening positive vs negative. However, patients who screened positive for cognitive impairment had a 49% higher rate of hospitalizations and 40% higher rate of emergency room visits.
P2-251
Poster Presentations: P2
COGNITIVE IMPAIRMENT IN PRIMARY CARE: PRACTICE PATTERNS AND ATTITUDES COMPARED TO NEUROLOGY
Lealani Mae Acosta, Raymond Romano, Angela L. Jefferson, Vanderbilt University, Nashville, TN, USA. Contact e-mail: lealani.mae.acosta@ vanderbilt.edu Background: Neurologists’ practice patterns and attitudes regarding diagnosing and treating mild cognitive impairment (MCI) have been explored previously (Roberts et al., 2010), but similar data about primary care provider (PCP) practice patterns and attitudes have not been reported. Because neurologists primarily receive referrals from PCPs, there is a need to assess how PCPs approach diagnosis, treatment, and specialty referrals of patients with MCI to determine any differences in practice patterns, including how to address such differences. We hypothesized that PCPs would vary from neurologists regarding both attitudes towards and treatment of MCI. Methods:
A survey (in both email and postal mail format) was distributed to 1274 PCPs (physicians 80%, physician assistants 20%) in the greater Nashville area. The survey included portions of the survey originally sent to neurologists in the Roberts et al., 2010 study (e.g., counseling and attitudes towards MCI) and original questions about referral practices (e.g., different clinical vignettes prompting referrals). Results: Our survey response rate was low (6.6%) compared to the Roberts et al., 2010 survey (48%). When comparing responses to questions administered in both surveys, Fisher’s exact test results suggested neurologists and PCPs have strikingly similar attitudes about the benefits and drawbacks of making the diagnosis of MCI (all p-values >0.09). Conversely, out of 13 counseling practices (e.g., support services, diet/nutrition), the PCPs differed from neurologists on 12 of these items (p<0.05), ranging from prescribing medication to counseling about other aspects of health. The only different counseling practice was providing a written summary to the patient, which just missed the a priori threshold for significance (p¼0.06). Conclusions: MCI may serve as a key point of intervention to delay progression to dementia, so early identification and treatment of these patients is crucial. These survey results demonstrate a disparity between PCPs and neurologists regarding how best to care for MCI patients, a finding that needs to be addressed to provide optimal care to this growing patient population, including appropriate referral for a more specialized memory loss work-up.
P2-252
CONCOMITANT USE OF PSYCHOTROPIC DRUGS IN PATIENTS WITH DEMENTIA
Ane Nørgaard1, Christina Jensen-Dahm1, Christiane Gasse2, Gunhild Waldemar3, 1Danish Dementia Research Centre, University of Copenhagen, Copenhagen, Denmark; 2National Centre for Register-based Research, Aarhus University, Aarhus, Denmark; 3Danish Dementia Research Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Contact e-mail: [email protected] Background: Antipsychotic drugs and other psychotropic drugs are frequently used to treat neuropsychiatric symptoms (NPS) in patients with dementia, even though the evidence for effect is limited. Patients with dementia are at increased risk of serious adverse events when treated with psychotropic drugs and the drugs should be used with caution. The extent of concomitant use of antipsychotic, anxiolytic, hypnotic/sedative and antidepressant drugs is unknown. Therefore, we aimed to investigate the prevalence and predictors of concomitant use of psychotropic drugs in patients with dementia in Denmark. Methods: Based on data from nationwide registers we included all patients with dementia (age65)
on January 1, 2012. We obtained information about redeemed prescriptions, demographics and somatic and psychiatric comorbidity. The treatment duration of all psychotropic prescriptions was calculated from the number of defined daily doses (DDD). Prescriptions with overlapping treatment periods were used to identify patients using more than one psychotropic drug concomitantly. Results: On January 1, 2012 we identified 34,553 patients with dementia (3.5%) among the 974,431 Danish residents aged 65. In 2012 concomitant use of 2 psychotropic drugs occurred in 25.3% of patients with dementia. 76.7% of patients with dementia using antipsychotics (N¼7043) received at least one other psychotropic drug concomitantly. The most frequent combination of psychotropic drugs was antipsychotic and antidepressant drugs and 68.4% of patients with dementia using antipsychotics received antidepressants concomitantly. Among nursing home residents with dementia (N¼17,080) 30.9% used 2 psychotropic drugs concomitantly and 71.0% of antipsychotic drug users (N¼4533) received antidepressants concomitantly. Conclusions: Concomitant use of psychotropic drugs was common in patients with dementia. Concomitant use of antipsychotics and antidepressants was the most frequent combination. Both drug classes have been associated with increased risk of serious adverse events and death, and it is unknown whether concomitant use is associated with an increased risk.
P2-253
PERFORMANCE ON COGNITIVE SCREENING IS ASSOCIATED WITH INCREASED RETROSPECTIVE HEALTHCARE UTILIZATION
Leah R. Hanson1,2, Terry R. Barclay1,2, Ann Hanson2, Logan Stuck2, Jean Crow1,2, Soo Borson3, Michael H. Rosenbloom1,2, 1HealthPartners Center for Memory and Aging, St. Paul, MN, USA; 2HealthPartners Institute for Education and Research, Bloomington, MN, USA; 3University of Washington, Seattle, WA, USA. Contact e-mail: leah.r.hanson@ healthpartners.com Background: Much dementia is not identified in health care environments until the moderate-severe stages. Screening for cognitive impairment can substantially improve detection, but has not been widely implemented in health care systems to date. HealthPartners has piloted the use of the Mini-Cog as a standardized screening tool for cognitive impairment in patients aged 65 and older to help establish a framework for promoting systematic outcomes research on patients with previously undetected cognitive impairment. In this preliminary study, we tested potential correlates of cognitive impairment in individuals who were later screened with the Mini-Cog, examining pre-screening indicators of chronic disease management and health care utilization. Methods: Patients screened within specialty or primary care clinics were identified. Data from the 18 months prior to screening were collected from the electronic medical record and included the Mini-Cog score (scored 0-5, a positive screen defined for this study as <4), demographics, diagnosis of three chronic conditions (diabetes, hypertension, hyperlipidemia), standard measures of control (HbA1c, blood pressure, lipid panel), and measures of healthcare utilization in a subset of patients (n¼819) with claims information. Data analysis consisted of Poisson regression and mixed effects regression. Results: The Mini-Cog was administered to 1,124 patients (average 77 yr, 58% female) and 32% screened positive. No significant differences in pre-screening measures of chronic disease control were found for those screening positive vs negative. However, patients who screened positive for cognitive impairment had a 49% higher rate of hospitalizations and 40% higher rate of emergency room visits.