Community, Social, and Facility Factors and Long-stay Antipsychotic Use

ABSTRACT

Objectives

Compare Virginia nursing homes in the top- and bottom-quintiles of antipsychotic use for variation in community, social, and facility factors.

Methods

2018 CMS data ascertained Virginia nursing homes in the top and bottom quintiles for antipsychotic use. The Virginia Health Department provided social determinant of health (SDOH) statistics for each facility’s county/city while claims identified facility demographics. Chi square and independent two-sample t-tests compared quintiles for regional, social, and demographic differences.

Results

Quintiles averaged 3000 residents and 56 facilities. Facilities with the lowest rates of antipsychotic use were more likely to be privately owned and had fewer African-American and minority residents and more white residents. All 18 SDOH statistics were superior for the communities of facilities with the lowest antipsychotic rates. Nine of these differences were statistically significant, including the aggregated “Health Opportunity Index.”

Conclusions

The antipsychotic prevalence rate for facilities in the top-quintile of antipsychotic use is fivefold the bottom-quintile’s rate. Antipsychotic prescribing in nursing homes is associated with regional, demographic, and social factors not addressed by existing antipsychotic reduction measures, with vulnerable populations at greatest risk.

Clinical Implications

The efficacy of measures aimed at curbing long-stay antipsychotic prescribing could be improved by addressing SDOH including economic opportunities.

KEYWORDS:

• antipsychotic
• dementia
• health opportunities
• nursing home
• social determinants of health

Acknowledgments

Supported in part by Commonwealth of Virginia’s Alzheimer’s and Related Diseases Research Award Fund [Awards 15-2, 18-3, 20-6], Virginia Center on Aging, School of Allied Health Professions, Virginia Commonwealth University, and by the Biostatistics, Epidemiology and the Research Design (BERD) core of the C. Kenneth and Dianne Wright Center for Clinical and Translational Research (CTSA award No. UL1TR002649 from the National Center for Advancing Translational Sciences).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Alzheimer’s and Related Diseases Research Award Fund [15-2, 18-3, 20-6] and and by the National Center for Advancing Translational Sciences [UL1TR002649].