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Psychoactive Medication Prescribing After Critical Illness in American Adults Not Justified by a Documented
Ting Ting Wu1,2, O Joseph Bienvenu3, Louisa H Smith1,4
1Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA.
Objectives:
To describe psychoactive medication (PM) prescribing in the 30 days after an ICU admission requiring mechanical ventilation not supported by a documented diagnosis in American adults not prescribed a PM before ICU admission. This nondiagnostically supported PM prescribing was explored in patient subgroups and for up to 2 years.
Design, Setting, And Patients:
This retrospective cohort study analyzed data from the U.S. claims database PharMetrics Plus for Academics for adults admitted to an ICU requiring invasive mechanical ventilation between January 1, 2018, and December 31, 2019. Patients prescribed a PM or admitted to an ICU or long-term care facility in the year prior, or who ended insurance coverage during the index hospitalization, were excluded.
Interventions:
None.
Measurements And Main Results:
Common and uncommon diagnostic codes potentially justifying each PM class prescription were identified using a literature review and expert consensus. A total of 416 of 7898 patients (5.3%) were newly prescribed 484 PMs across four PM classes in the 30-day postdischarge period [193 anxiolytics (39.9%), 176 antidepressants (36.2%), 103 antipsychotics (21.3%), and 12 sleep aids (2.5%)]. A total of 207 prescriptions (42.8%) of these 484 PM prescriptions were not accompanied by a documented supporting diagnosis: 54 of 103 antipsychotics (52.4%), 88 of 193 anxiolytics (45.6%), 5 of 12 sleep aids (41.7%), and 60 of 176 antidepressants (44.1%). Patient subgroups significantly associated with greater 30-day PM prescribing not supported by a documented diagnosis were: younger than 65 (antipsychotics); no history of dementia (anxiolytics); a discharge to home (antidepressants, antipsychotics); and ICU readmission (sleep aids). New PM prescribing in the absence of a supporting documented diagnosis persisted over the next 2 years (31-90 d, 24.7%; 91-180 d, 37.8%; 181-365 d, 42.7%; 366-730 d, 36.6%).
Conclusions:
Although the prevalence of new PM prescribing to American ICU survivors in the 30 days after discharge is relatively low, nearly half is not supported by a documented diagnosis. Future prospective research should determine the prevalence of nondiagnostically documented PM prescribing that is unwarranted.
Insights
Nearly half of psychoactive medication prescriptions for ICU survivors lacked a documented diagnosis. This trend of non-diagnostically supported prescribing continued for up to two years post-discharge.
Area of Science:
- Pharmacology
- Critical Care Medicine
- Health Services Research
Background:
- Psychoactive medication (PM) use after intensive care unit (ICU) admission is common.
- Understanding the diagnostic justification for new PM prescriptions post-ICU is crucial for appropriate patient care.
Purpose of the Study:
- To investigate the rate of new psychoactive medication prescribing within 30 days of ICU discharge among American adults.
- To determine the proportion of these prescriptions lacking a documented supporting diagnosis.
- To analyze prescribing patterns in subgroups and over a two-year period.
Main Methods:
- Retrospective cohort study using the PharMetrics Plus for Academics claims database.
- Included adults admitted to ICU requiring invasive mechanical ventilation (2018-2019).
- Excluded patients with prior PM use, prior ICU/LTC admission, or insurance gaps.
Main Results:
- 5.3% of eligible patients received new PMs (484 total) within 30 days post-discharge.
- 42.8% of these new PM prescriptions lacked a documented supporting diagnosis.
- Nondiagnostically supported prescribing was associated with younger age, no dementia history, home discharge, and ICU readmission, persisting long-term.
Conclusions:
- While new PM prescribing post-ICU is not highly prevalent, a significant portion lacks diagnostic support.
- Further research is needed to assess the appropriateness of nondiagnostically documented PM prescribing in ICU survivors.
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