Lisa W. Goldstone

Prevalence, Patterns and Predictors of Psychotropic Polypharmacy Among Elderly Individuals with Parkinson's Disease In Long Term Care Settings In The United States

BACKGROUNDnElderly individuals with Parkinsons disease (PD) generally suffer from more than one psychiatric comorbidity, which necessitates the use of concurrent psychotropic medications. To the best of the authors knowledge there are no nationally representative estimates of psychotropic polypharmacy among elderly individuals with PD in the United States (US).nnnOBJECTIVEnTherefore, the primary objective of this study was to examine the prevalence, patterns and predictors of psychotropic polypharmacy among elderly individuals with PD in the (US).nnnMETHODSnA retrospective, cross-sectional study design with 2004 National Nursing Home Survey (NNHS) and 2007 National Home and Hospice Care Survey (NHHCS) data was used. The analytic sample included elderly (age ≥65 years) individuals with PD. Antidepressants, antipsychotics, sedative/hypnotics, and anti-anxiety medications constituted the psychotropic medication classes. Concurrent use of two or more psychotropic medications was classified as psychotropic polypharmacy.nnnRESULTSnApproximately 93,648 and 37,439 elderly individuals with PD resided in nursing homes and home health settings respectively. Among elderly nursing home residents with PD, the nationally representative prevalence of psychotropic polypharmacy was 26.28%, whereas, it was 21.36% in the home health setting. Use of antidepressant medications constituted the majority of the psychotropic medication use among both nursing home (48.91%) and home health (40.98%) residents with PD. Multiple logistic regression analyses revealed that specific comorbidities were significantly associated with psychotropic polypharmacy among elderly nursing home residents with PD.nnnCONCLUSIONSnThese findings underscore the importance of evidence-based prescribing when psychotropic medications are used in elderly individuals with PD to reduce unnecessary polypharmacy.

An Interprofessional Psychiatric Advanced Pharmacy Practice Experience

Objective. To create an interprofessional psychiatry advanced pharmacy practice experience (APPE) and assess the initial outcomes. Design. An elective psychiatry APPE was developed in a setting of interdisciplinary practice. Preceptor responsibilities were shared between a psychiatric pharmacist and an attending psychiatrist or psychiatric nurse practitioner. Students were also given the opportunity to shadow and work with other health care professionals such as nurses, social workers, therapists, family nurse practitioners, and utilization review staff members. Assessment. Midpoint and final evaluations demonstrated student advancement throughout the experience as well as the development of communication skills with patients and an increased ability to work collaboratively with other health care providers. Students rated this practice experience highly and their comments reflected achievement of the established learning objectives. Conclusion. An interdisciplinary elective practice experience in psychiatry at a local teaching hospital was effective in teaching psychiatric care and interprofessional interaction. This teaching model can be adapted for use in other practice settings or specialty areas.

Patterns and Predictors of Depression Treatment among Stroke Survivors with Depression in Ambulatory Settings in the United States

GOALnDespite the importance of treating depression, little is known regarding the current practice pattern of depression treatment among older adults with stroke and depression. We used national survey data from ambulatory settings to examine the depression treatment patterns and predictors among stroke survivors in the United States (US).nnnMATERIALS AND METHODSnWe used a cross-sectional study design by pooling multiple-year data (2005-2011) from the National Ambulatory Medical Care Survey and the outpatient department of the National Hospital Ambulatory Medical Care Survey. Older adults (age ≥50 years) with stroke and depression constituted the final study sample. Depression treatment defined as antidepressant use with or without psychotherapy was the dependent variable in this study. All analyses adjusted for the complex survey design of the datasets to obtain nationally representative estimates.nnnFINDINGSnThe overall depression treatment was observed in 47.32% of the study sample, mainly driven by antidepressant use alone. An overwhelming majority used selective serotonin reuptake inhibitors (77% of overall antidepressant use), and sertraline was the most prescribed antidepressant (30.5% of overall antidepressant use). Gender, race or ethnicity, region of residence, number of medications recorded at the sampled visit, and number of chronic conditions were significantly associated with depression treatment.nnnCONCLUSIONnAccording to this nationally representative sample, approximately 1 in 2 stroke survivors with depression received depression treatment in ambulatory care settings in the US. Appropriate interventions should be developed to optimize depression treatment.

A Rasch analysis of a questionnaire designed to evaluate psychiatric patient attitudes and knowledge after attending a pharmacist-led patient medication education group.

BACKGROUNDnThere are many barriers that prevent persons with mental health disorders from achieving remission, including medication nonadherence. Research on the impact of pharmacist-led patient medication education groups on patient attitudes, knowledge and adherence is limited.nnnOBJECTIVEnTo evaluate the reliability and validity of the Medication Attitudes and Knowledge Questionnaire (MAKQ).nnnMETHODSnA retrospective pre-post questionnaire was distributed to patients. Variables collected included: patient self-reported medication knowledge and attitudes, patient demographics, number of previous psychiatric hospitalizations, whether the patient attended the whole meeting or only a portion, and outpatient pharmacist relationships. Knowledge and attitude items were measured on a 4-point scale with a range of options from Agree to Disagree. Rasch analysis was conducted to ensure all items measured the same construct and to assess scale and item reliability and validity. Additionally, the Rasch technique evaluated the change in each persons self-perceived attitudes, knowledge, and confidence in self-managing medications from pre- to post-intervention if the data fit the model. A z-test was used to evaluate gaps in content validity.nnnRESULTSnSixty patients responded to the MAKQ over the 16-week data collection period. Analysis showed that the 4-point rating scale was not useful and that negatively worded items should be eliminated. Gaps identified in instrument item content were not statistically significant (pxa0>xa00.05), indicating comprehensive content validity.nnnCONCLUSIONSnMedication attitudes and knowledge items on the retrospective pre-post questionnaire were valid and reliable.

Depression Screening Patterns, Predictors, and Trends Among Adults Without a Depression Diagnosis in Ambulatory Settings in the United States

OBJECTIVEnThis study examined national patterns, predictors, and trends in depression screening among adults without a diagnosis of depression in the United States.nnnMETHODSnA cross-sectional design utilizing pooled data from the National Ambulatory Medical Care Survey (2005-2015) was used. The study sample consisted of ambulatory care visits to nonpsychiatrists among adults (≥18 years) without a depression diagnosis. Depression screening was the dependent variable. Descriptive statistics, logistic regression, and piecewise regression analyses were conducted to achieve the study objectives.nnnRESULTSnThe national-level depression screening rate was 1.4% of all adult ambulatory care visits. Year, gender, physician specialty, geographic region, and time spent with physician were significantly associated with depression screening. Piecewise regression analysis revealed a statistically significant (p<.001) interaction between year and change in depression screening rate, where screening rates increased significantly after 2009.nnnCONCLUSIONSnAlthough screening rates have increased significantly after 2009, screening remains low among adults without a depression diagnosis.

Patterns and Predictors of Depression Treatment among Older Adults with Parkinson’s Disease and Depression in Ambulatory Care Settings in the United States

Little is known regarding depression treatment patterns and predictors among older adults with comorbid Parkinsons disease and depression (dPD) in the United States (US). The objective of this study was to assess the patterns and predictors of depression treatment among older adults with dPD in the US. We adopted a cross-sectional study design by pooling multiple-year data (2005–2011) from the National Ambulatory Medical Care Survey (NAMCS) and the outpatient department of the National Hospital Ambulatory Medical Care Survey (NHAMCS). The final study sample consisted of visits by older adults with dPD. Depression treatment was defined as antidepressant use with or without psychotherapy. To identify predictors of depression treatment, multivariate logistic regression analysis was conducted adjusting for predisposing, enabling, and need factors. Individuals with dPD and polypharmacy were 74% more likely to receive depression treatment (odds ratiou2009=u20091.743, 95% CI 1.376–2.209), while dPD subjects with comorbid chronic conditions were 44% less likely (odds ratiou2009=u20090.559, 95% CI 0.396–0.790) to receive depression treatment. Approximately six out of ten older adults with PD and depression received depression treatment. Treatment options for dPD are underutilized in routine clinical practice, and further research should explore how overall medical complexity presents a barrier to depression treatment.

Curriculum in Psychiatry and Neurology for Pharmacy Programs

Objective. To describe pharmacy curricula in psychiatry and neurology and to report on neuropsychiatric pharmacy specialists’ views on optimal curriculum. Methods. Design and administer one electronic survey to accredited pharmacy programs asking them to report information on curricula in psychiatry and neurology for the 2014-2015 academic year. Design and administer a separate electronic survey to board certified pharmacists with an academic affiliation who are members of the College of Psychiatric and Neurologic Pharmacists (CPNP) asking about their teaching activities and their opinion on optimal curricula. Results. Fifty-six percent of pharmacy programs and 65% of CPNP members responded to the surveys. The program survey revealed greater than 80% of topics were taught by full-time faculty. Didactic lecturing, team-based learning, and case studies were the most common teaching methods. Programs dedicated the most didactics (3 to 5+ hours) to epilepsy, depression, schizophrenia, substance use disorders, and pain. Autism, traumatic brain injury, personality, and eating disorders were either not taught or given ≤ 1 hour of didactics in most programs. Inpatient psychiatry had the most APPE placements with a mean of 19.6, range 0-83. APPE electives in psychiatry outnumbered those in neurology 5 to 1. CPNP member survey results showed 2 out of 3 members agreed that curriculum could be improved with additional APPEs in psychiatry and neurology. Conclusion. Didactic hour distribution in psychiatry and neurology could be improved to better align with board certification in psychiatric pharmacy (BCPP) recommendations and disorder prevalence and complexity. Specialists recommend an experiential component in neurology and psychiatry to combat stigma and improve pharmacist knowledge and skills.

Depression Treatment among Adults with Multiple Sclerosis and Depression in Ambulatory Care Settings in the United States

Background. There is little information regarding depression treatment patterns among adults with MS and depression in ambulatory settings at national level in the United States (US). Objectives. The objectives of this study were to identify patterns and predictors of depression treatment in ambulatory settings in US among adults with MS and depression. Methods. A cross-sectional study was conducted by pooling multiple years (2005–2011) of National Ambulatory Medical Care Survey and the outpatient department of the National Hospital Ambulatory Medical Care Survey data. The final study sample was comprised of ambulatory visits among adults with MS and depression. Dependent variable of this study was pharmacological treatment for depression with or without psychotherapy. Predictors of depression treatment were determined by conducting multivariable logistic regression. Results. Out of all ambulatory visits involving MS diagnosis, 20.59% also involved a depression diagnosis. Depression treatment was observed in 57.25% of the study population. Fluoxetine was the most prescribed individual antidepressant. Age and total number of chronic diseases were significant predictors of depression treatment. Conclusion. Approximately six out of ten ambulatory visits involving MS and depression recorded some form of depression treatment. Future longitudinal studies should examine health outcomes associated with depression treatment in this population.

National Estimates of Prevalence and Patterns of Psychotropic Polypharmacy Among Elderly Individuals with Parkinson’s Disease in Nursing Home and Home Healthcare Settings in the United States

PND11 NatioNal estimates of PrevaleNce aND PatterNs of PsycHotroPic PolyPHarmacy amoNg elDerly iNDiviDuals witH ParkiNsoN’s Disease iN NursiNg Home aND Home HealtHcare settiNgs iN tHe uNiteD states Bhattacharjee S, Goldstone L, Warholak T The University of Arizona, Tucson, AZ, USA Objectives: Some elderly individuals with Parkinson’s disease (PD) may suffer from more than one psychiatric comorbidity, which necessitates the use of concurrent psychotropic medications. To the best of the author’s knowledge there are no nationally representative estimates of psychotropic polypharmacy among elderly individuals with PD in the United States. Therefore, the primary objective of this study was to examine the prevalence and patterns of psychotropic polypharmacy among elderly individuals with PD. MethOds: A retrospective, cross-sectional study design with 2004 National Nursing Home Survey (NNHS) and 2007 National Home and Hospice Care Survey (NHHCS) data was used. The analytic sample included elderly (age ≥ 65 years) individuals with PD (identified by ICD-9-CM code of 332.xx). Antidepressants, antipsychotics, sedative/hypnotics, and anti-anxiety medications constituted the psychotropic medication classes. Concurrent use of two or more psychotropic medications was classified as psychotropic polypharmacy. National estimates of psychotropic medication use were obtained by using SAS survey procedures. Results: National estimate of approximately 93,648 [95% Confidence Interval (CI), 86535 – 100,761] and 37,439 (95% CI, 25,910 – 48,968) elderly individuals with PD resided in nursing homes and home health settings respectively. Among elderly nursing home residents with PD, the nationally representative prevalence of psychotropic polypharmacy was 26.28% (95% CI, 22.81% – 29.75%), whereas, it was 21.36% (95% CI, 8.12% – 34.6%) in the home health setting. Use of antidepressant medications constituted the majority of the psychotropic medication use among both nursing home (48.91%, 95% CI, 44.9% – 52.8%) and home health (40.98%, 95% CI, 25.37% 56.61%) residents with PD. Nearly one-third (31.26%, 95% CI, 27.6% 34.9%) nursing home residents with PD were prescribed antipsychotic medications among whom less than one-fourth had a documented psychotic diagnosis. cOnclusiOns: These findings underscore the importance of evidence-based prescribing when psychotropic medications are used in elderly individuals with PD to reduce unnecessary polypharmacy.