The journal of nutrition, health & aging

, Volume 14, Issue 8, pp 677–683 | Cite as

Clinic visits and prescribing patterns among veterans affairs maryland health care system dementia patients

  • G. B. Rattinger
  • C. D. Mullins
  • I. H. Zuckerman
  • E. Onukwugha
  • S. Delisle
JNHA: Clinical Neurosciences

Abstract

Objective

Our objective was to determine how patient demographics and outpatient referrals to specialized dementia (DEM) or mental health (MH) clinics influence receipt of anti-dementia (AD), antidepressant (ADEP), antipsychotic (APSY) and sedative-hypnotic (SEDH) medications among veterans with dementia.

Design

Retrospective, cross-sectional observational study.

Setting

Veterans Affairs Maryland Health Care System (VAMHCS).

Participants

Veterans aged ≥ 60 years with Alzheimer's or related dementia diagnosis after 1999 with minimum of one-year follow-up or death were included.

Measurements

Retrospective analysis of VAMHCS electronic medical records were used to determine predictors of AD, ADEP, APSY, and SEDH prescribing using logistic regression models that examined visits to DEM or MH clinics, patient age, follow-up time, race/ethnicity and marital status.

Results

Among 1209 veterans with average follow-up of 3.2 (SD 1.9) years, 36% percent had MH visits, 38% had DEM visits and 19% visited both clinics. DEM visits were associated with AD and ADEP but not APSY medication receipt (OR(AD:DEM) = 1.47, 95% CI = (1.052, 2.051); OR(ADEP:DEM) = 1.66, 95% CI = (1.193, 2.302); OR(APSY:DEM) = 1.35, 95% CI = (0.941, 1.929)). MH visit was associated with ADEP and APSY medication receipt (OR(AD:MH)/ = 1.16, 95% CI = (0.821, 1.631); OR(ADEP:MH) = 2.83, 95% CI = (2.005, 4.005); OR (APSY:MH) = 4.41, 95% CI = (3.109, 6.255)).

Conclusion

In the VAMHCS dementia population, visits to DEM or MH specialty clinics increase the odds of receiving AD, ADEP, and APSY medications.

Key words

Alzheimer's disease dementia Veterans Affairs Health Care System Electronic Medical Record 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Grossberg GT. Diagnosis and treatment of Alzheimer's disease. J Clin Psychiatry. 2003;64Suppl 9:3–6.PubMedGoogle Scholar
  2. 2.
    Grossberg GT, Desai AK. Management of Alzheimer's disease. J Gerontol A Biol Sci Med Sci. Apr 2003;58(4):331–353.Google Scholar
  3. 3.
    2009 Alzheimer's Disease Facts and Figures. http://www.alz.org
  4. 4.
    Boustani M, Peterson B, Hanson L, Harris R, Lohr KN. Screening for dementia in primary care: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. Jun 3 2003;138(11):927–937.PubMedGoogle Scholar
  5. 5.
    Holsinger T, Deveau J, Boustani M, Williams JW, Jr. Does this patient have dementia? Jama. Jun 6 2007;297(21):2391–2404.CrossRefPubMedGoogle Scholar
  6. 6.
    Brookmeyer R, Johnson E, Ziegler-Graham K, Arrighi HM. Forecasting the global burden of Alzheimer's disease. Alzheimers Dement. Jul 2007;3(3):186–191.CrossRefPubMedGoogle Scholar
  7. 7.
    Rice DP, Fillit HM, Max W, Knopman DS, Lloyd JR, Duttagupta S. Prevalence, costs, and treatment of Alzheimer's disease and related dementia: a managed care perspective. Am J Manag Care. Aug 2001;7(8):809–818.PubMedGoogle Scholar
  8. 8.
    Malone DC, McLaughlin TP, Wahl PM, et al. Burden of Alzheimer's disease and association with negative health outcomes. Am JManag Care. Aug 2009;15(8):481–488.Google Scholar
  9. 9.
    Hill JW, Futterman R, Duttagupta S, Mastey V, Lloyd JR, Fillit H. Alzheimer's disease and related dementias increase costs of comorbidities in managed Medicare. Neurology. Jan 8 2002;58(1):62–70.PubMedGoogle Scholar
  10. 10.
    Fillit H, Hill JW, Futterman R. Health care utilization and costs of Alzheimer's disease: the role of co-morbid conditions, disease stage, and pharmacotherapy. Fam Med. Jul–Aug 2002;34(7):528–535.PubMedGoogle Scholar
  11. 11.
    Doody RS, Stevens JC, Beck C, et al. Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. May 8 2001;56(9):1154–1166.PubMedGoogle Scholar
  12. 12.
    Pomara N, Ott BR, Peskind E, Resnick EM. Memantine treatment of cognitive symptoms in mild to moderate Alzheimer disease: secondary analyses from a placebo-controlled randomized trial. Alzheimer Dis Assoc Disord. Jan–Mar 2007;21(1):60–64.CrossRefPubMedGoogle Scholar
  13. 13.
    Raina P, Santaguida P, Ismaila A, et al. Effectiveness of cholinesterase inhibitors and memantine for treating dementia: evidence review for a clinical practice guideline. Ann Intern Med. Mar 4 2008;148(5):379–397.PubMedGoogle Scholar
  14. 14.
    Mayeux R, Sano M. Treatment of Alzheimer's disease. N Engl J Med. Nov 25 1999;341(22):1670–1679.CrossRefPubMedGoogle Scholar
  15. 15.
    Reisberg B, Doody R, Stoffler A, Schmitt F, Ferris S, Mobius HJ. Memantine in moderateto-severe Alzheimer's disease. N Engl J Med. Apr 3 2003;348(14):1333–1341.CrossRefPubMedGoogle Scholar
  16. 16.
    Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. Jama. Oct 19 2005;294(15):1934–1943.CrossRefPubMedGoogle Scholar
  17. 17.
    Schneider LS, Tariot PN, Dagerman KS, et al. Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. N Engl J Med. Oct 12 2006;355(15):1525–1538.CrossRefPubMedGoogle Scholar
  18. 18.
    Mitchell AJ. Depression as a risk factor for later dementia: a robust relationship? Age Ageing. May 2005;34(3):207–209.CrossRefPubMedGoogle Scholar
  19. 19.
    Pfennig A, Littmann E, Bauer M. Neurocognitive impairment and dementia in mood disorders. J Neuropsychiatry Clin Neurosci. Fall 2007;19(4):373–382.PubMedGoogle Scholar
  20. 20.
    Kohn R, Epstein-Lubow G. Course and outcomes of depression in the elderly. Curr Psychiatry Rep. Feb 2006;8(1):34–40.CrossRefPubMedGoogle Scholar
  21. 21.
    Kaup BA, Loreck D, Gruber-Baldini AL, et al. Depression and its relationship to function and medical status, by dementia status, in nursing home admissions. Am J Geriatr Psychiatry. May 2007;15(5):438–442.CrossRefPubMedGoogle Scholar
  22. 22.
    Hargrave R, Reed B, Mungas D. Depressive syndromes and functional disability in dementia. J Geriatr Psychiatry Neurol. Summer 2000;13(2):72–77.CrossRefPubMedGoogle Scholar
  23. 23.
    Chronic Condition Data Warehouse, User Manual. http://www.resdac.umn.edu/CCW/data_available.asp. Accessed October 1, 2009.
  24. 24.
    McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. Jul 1984;34(7):939–944.PubMedGoogle Scholar
  25. 25.
    Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. May 8 2001;56(9):1143–1153.PubMedGoogle Scholar
  26. 26.
    Pressley JC, Trott C, Tang M, Durkin M, Stern Y. Dementia in community-dwelling elderly patients: A comparison of survey data, medicare claims, cognitive screening, reported symptoms, and activity limitations. J Clin Epidemiol. Sep 2003;56(9):896–905.CrossRefPubMedGoogle Scholar
  27. 27.
    Taylor DH, Jr., Fillenbaum GG, Ezell ME. The accuracy of medicare claims data in identifying Alzheimer's disease. J Clin Epidemiol. Sep 2002;55(9):929–937.CrossRefPubMedGoogle Scholar
  28. 28.
    Newcomer R, Clay T, Luxenberg JS, Miller RH. Misclassification and selection bias when identifying Alzheimer's disease solely from Medicare claims records. J Am Geriatr Soc. Feb 1999;47(2):215–219.PubMedGoogle Scholar
  29. 29.
    Bertram L, Tanzi RE. Thirty years of Alzheimer's disease genetics: the implications of systematic meta-analyses. Nat Rev Neurosci. Oct 2008;9(10):768–778.CrossRefPubMedGoogle Scholar
  30. 30.
    Bertram L, Lange C, Mullin K, et al. Genome-wide association analysis reveals putative Alzheimer's disease susceptibility loci in addition to APOE. Am J Hum Genet. Nov 2008;83(5):623–632.CrossRefPubMedGoogle Scholar
  31. 31.
    Bertram L, Tanzi RE. Of replications and refutations: the status of Alzheimer's disease genetic research. Curr Neurol Neurosci Rep. Sep 2001;1(5):442–450.CrossRefPubMedGoogle Scholar
  32. 32.
    Zuckerman IH, Ryder PT, Simoni-Wastila L, et al. Racial and ethnic disparities in the treatment of dementia among Medicare beneficiaries. J Gerontol B Psychol Sci Soc Sci. Sep 2008;63(5):S328–333.PubMedGoogle Scholar
  33. 33.
    Mehta KM, Yin M, Resendez C, Yaffe K. Ethnic differences in acetylcholinesterase inhibitor use for Alzheimer disease. Neurology. Jul 12 2005;65(1):159–162.CrossRefPubMedGoogle Scholar
  34. 34.
    Lerner AJ, McClendon MJ, Sami SA, Ogrocki PK, Adams KB, Smyth KA. Factors affecting usage patterns of memantine in Alzheimer disease. Alzheimer Dis Assoc Disord. Apr–Jun 2008;22(2):137–143.CrossRefPubMedGoogle Scholar
  35. 35.
    Froehlich TE, Bogardus ST, Jr., Inouye SK. Dementia and race: are there differences between African Americans and Caucasians? J Am Geriatr Soc. Apr 2001;49(4):477–484.CrossRefPubMedGoogle Scholar
  36. 36.
    Johnson KS, Elbert-Avila KI, Tulsky JA. The influence of spiritual beliefs and practices on the treatment preferences of African Americans: a review of the literature. J Am Geriatr Soc. Apr 2005;53(4):711–719.CrossRefPubMedGoogle Scholar
  37. 37.
    Roberts JS, Connell CM, Cisewski D, Hipps YG, Demissie S, Green RC. Differences between African Americans and whites in their perceptions of Alzheimer disease. Alzheimer Dis Assoc Disord. Jan–Mar 2003;17(1):19–26.CrossRefPubMedGoogle Scholar
  38. 38.
    Hillmer M, Krahn M, Hillmer M, Pariser P, Naglie G. Prescribing patterns for Alzheimer disease: survey of Canadian family physicians. Can Fam Physician. Feb 2006;52:208–209.PubMedGoogle Scholar
  39. 39.
    Ruof J, Mittendorf T, Pirk O, von der Schulenburg JM. Diffusion of innovations: treatment of Alzheimer's disease in Germany. Health Policy. Apr 2002;60(1):59–66.CrossRefPubMedGoogle Scholar
  40. 40.
    Shen Y, Hendricks A, Li D, Gardner J, Kazis L. VA-Medicare dual beneficiaries’ enrollment in Medicare HMOs: access to VA, availability of HMOs, and favorable selection. Med Care Res Rev. Aug 2005;62(4):479–495.CrossRefPubMedGoogle Scholar
  41. 41.
    Shen Y, Hendricks A, Zhang S, Kazis LE. VHA enrollees’ health care coverage and use of care. Med Care Res Rev. Jun 2003;60(2):253–267.CrossRefPubMedGoogle Scholar
  42. 42.
    Borowsky SJ, Cowper DC. Dual use of VA and non-VA primary care. J Gen Intern Med. May 1999;14(5):274–280.CrossRefPubMedGoogle Scholar

Copyright information

© Serdi and Springer Verlag France 2010

Authors and Affiliations

  • G. B. Rattinger
    • 1
  • C. D. Mullins
    • 1
  • I. H. Zuckerman
    • 1
  • E. Onukwugha
    • 1
  • S. Delisle
    • 2
    • 3
  1. 1.Pharmaceutical Health Services Research DepartmentUniversity of Maryland School of PharmacyBaltimoreUSA
  2. 2.Division of Pulmonary and Critical Care MedicineUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Veterans Affairs Maryland Health Care SystemBaltimoreUSA

Personalised recommendations