QUALITY OF PHARMACEUTICAL CARE IN DEMENTIA PATIENTS

Abstract

OBJECTIVES: Use of potentially inappropriate medications (PIM) in dementia patients reflect poor quality of care. The goal of this study was to evaluate quality of pharmaceutical care in dementia patients using the most recent 2015 American Geriatric Society (AGS) Beers criteria. METHODS: This cohort study used the 5% national Medicare data from 2011–2012. The cohort included elderly patients diagnosed with dementia in the baseline year, i.e. 2011. Quality of care, i.e., use of PIMs, was defined in 2012 using the AGS Beers criteria. Predictors were identified in the baseline year based on the Andersen Behavioral Model: predisposing (sociodemographic), enabling (dual eligibility) and need factors (Elixhauser comorbidities, medication use and healthcare utilization). Descriptive statistics was used to determine the prevalence of PIMs. Multivariable logistic regression analysis was used to determine predictors of PIMs in dementia patients. RESULTS: The cohort included 57,469 elderly dementia patients, with mean age of 85 ± 8 years. Overall, 53.1% of dementia patients received PIMs. The prevalence of top seven drugs classes were as follows: antipsychotics (31.3%), H2-receptor antagonists (11.3%), antihistamines (10.3%), antimuscarinic urinary incontinence (9.1%), antiemetics (6.7%), nonbenzodiazepine receptor agonist hypnotics (6.1%), tricyclic antidepressants (5.7%). Mutivariable logistic regression found that females (odds ratio [OR], 1.16), Blacks (OR, 1.18), patients with Elixhauser comorbidities (twelve conditions), emergency room visit (OR, 1.1) and more than five prescription medications (OR, 3.0) were associated with higher likelihood of receiving PIMs. CONCLUSIONS: One out of two dementia patients received at least one PIMs reflecting poor quality of pharmaceutical care in this vulnerable patient population.