Evaluation Of Pharmacist Impact On Antipsychotic And Benzodiazepine Utilization During Veterans With Dementia

Non-pharmacological interventions, such as validation therapy, are the first line approach to manage BPSD. However, in emergency cases where there is safety risk for the person with dementia and others, the pharmacological intervention or psychotropic drug are used. Psychotropic drug includes neuroleptics, anxiolytics and antidepressants. Additionally, to improve cognitive function, memory enhancement drugs such as cholinesterase inhibitors are

In the past few years there has been increasing discussion about how to provide adequate care for the increasing number of veterasn who are eligible for care through the Veterans’ healthcare administration (VHA). There are concerns is that the VHA is not providing the level of access, efficiency, and quality of care that veterans expect. Lee & Begley, (2016) suggest access to care for the veteran population may be resulting in poor health outcomes. In response to these concerns, the Veterans ' Access to Care through Choice, Accountability, and Transparency Act (VACAA) of 2014, also known as the Veterans Choice Act, was created to improve Veterans’ healthcare. The VACAA proposed to do this by expanding the number of options veterans have for receiving healthcare, by providing access for healthcare at non-VA care centers as well as providing for an increase in staffing at VA facilities (U. S. Department of Veterans Affairs, 2016).

All elements in this domain scored a five. The VHA focuses on diversity and disparities among Veterans. The comprehensive electronic health record captures demographic information, such as race, ethnicity, language on the initial visit to the facility. This information can then be viewed in the first pane of the patient chart. Although English is the primary language, an interpreter can be made available if necessary. Those patients who are hearing impaired are provided with an interpreter fluent in sign language. Multiple programs are available to Veterans who are underserved. A series of questions are reviewed with the patient annually, with the goal of identifying the Veteran’s needs. These questions focus on routine health care, as well

About 57,436 Veterans chose to use Non-VA (Department of Veterans Affairs) facilities for healthcare service while waiting more than 90 days for appointments with their VA clinicians (Couzner, Ratcliffe, & Crotty 2012). Since post-hospitalization follow-up with primary care providers has a great impact on theses Veterans’ health outcome by promoting recovery and preventing readmissions (Martinez, 2014). The Patient Aligned Care Teams track Veterans’ admission and discharge in VA facilities through the VA’s electronic medical record to ensure timely post-hospitalization with Veterans’ primary care providers. There are no data about post-hospitalization follow up among Veterans who is admitted into Non-VA facilities.

Phillips states that individuals with dementia often display resistance to care, confusion, disruptive or aggressive behaviors: For these reasons, many seniors who are not actually suffering from psychosis are given antipsychotic medications. The goal of the pan-Canadian Reducing Antipsychotic Medication in Long Term Care program was to encourage long-term care facilities and nursing homes to discontinue the use of unnecessary antipsychotic medications to experiment with alternative therapies.

Participating PCPs must register under the Veterans Choice Program (VCP). The non-VA provider must be a Medicare participant, has a non-constraint state license, drug enforcement administration licensed, have no penalties and furnish a type 1 or type 2 National Provider Identifier (Veteran Services, 2016). Establishing a legal authorization for outpatient care, which is the VA form 10-7079, request for outpatient services (Appendix A). This record is given to both the veteran and the Non-VA provider earlier to receipt of care (A Guide for Providers, 2014). Consent to care is the foundation for carrying out purchased care and the plan for financing a claim appropriately. The authorization allows the non-VA medical entity to give and provide medical care to the veteran patient, and gives a guarantee of reimbursement for the medical services provided. Sufficiently acknowledging the demands of veterans’ desires further than knowledge about rampant existing conditions and special programs structured for veterans (William & Jackson, 2015). Included in this intervention is a tri-fold brochure (Appendix B) that will be available in the primary care practices that will help in understanding peer support specialist services in the VHA. The objective of this peer support program tri-fold brochure is to present contingency for Veterans to take responsibility in their own rehabilitation, to make Veterans cognizant of the procurable services and opportunities, to help Veterans establish a sense of wellbeing and self-satisfaction and to carry out a unique attitude to the therapeutic teams on which they strive to work on (Ellison et al.

Inappropriate prescribing commonly occurs in adults aged 65 or older, who have a higher prevalence of chronic disease, disability, and dependency (Page II, Linnebur, Bryant, & Ruscin, 2010). Exposure to inappropriate medications is associated with increased morbidity, mortality, and health care utilization (Page II, Linnebur, Bryant, & Ruscin, 2010). Below is a list of measures that concentrate on the prescribing of correct medications in the hospital

Psychotropic medications are approved by the US Food and Drug Administration (FDA) primarily for the treatment of psychosis and mood disturbances associated with schizophrenia or bipolar disorders (Grunier, 2008). Despite FDA black box warnings related to the “off-label” use of these medications in the dementia population, a survey conducted by the Office of Inspector General in 2011 found that 86% to 95% of nursing home residents received these medications for other indications, such as managing behavioral disturbances associated with dementia (Chiu, 2015). It is the overuse and misuse of psychotropic medications, in particular as a strategy to subdue residents, that has designated these drugs to be labeled

Cerebrovascular effects are also possible, however, a patients could bring this upon themselves if they become extremely agitated and heightened their blood pressure and heart rate past the normal range. Antipsychotic drugs help control this by keeping their moods much more constant, which keeps them from getting worked up and increasing their heart rate and blood pressure. Most dementia patients already have other health problems and by them not taking antipsychotics it could do more harm than good. Antipsychotic drugs are not for every dementia patient, but in some cases their quality of life can be greatly improved by the drug. It is ultimately the patient’s doctor’s and caregiver’s decision whether antipsychotics are the best form of treatment for them. I have personally seen the benefits in my great grandmother and believe the medications, when used the right way, can be very advantageous. She has advanced dementia and was put on the antipsychotic drug Xanax, which has greatly improved her quality of life. The downsides of the drug definitely do not outweigh the benefits it offers

There are so many different kinds of medications used to treat patients, but the most common ones that psychiatric assistants prescribe exist as antipsychotic and antidepressants. Antidepressants usually relate to a substance that treats mood disorders. Antipsychotic medications usually are taken daily in pills or liquid form. However, some may get injected, which means their only given once or twice a month. The biggest mental disorder that antipsychotic are prescribed for has occurred in patients with schizophrenia. “Schizophrenia is a psychosis characterized by delusions, hallucinations, apathy, and a “split” between thought and emotion.” (Coon & Mitterer 487) “Patients with this disorder tend to have withdrawal from contact with other, a loss of interest in external activities, a breakdown of personal habits, and an inability to deal with daily events.” (486) “Also, it is hard for patients with schizophrenia to focus on one item of information at a time.” (486) Four major types of schizophrenia consist of catatonic, disorganized, paranoid, and undifferentiated. The first type, catatonic, involves disturbances in a person’s movement. Patients with this disorder type tend to just sit there and they do not talk or move. They show no emotion. “The second type, disorganized, or known as “hebephrenic schizophrenia”, patients experience bizarre thinking and flat or grossly inappropriate emotions.” (487) “Typically, this type of schizophrenia develops in adolescence or young adulthood.” (487) “The third type, paranoid, is marked by a preoccupation with delusions or by frequent auditory hallucinations related to a single theme, especially grandeur or persecution.” (488) “Patients think that God, the government, or “cosmic rays from space” are controlling their minds or trying to poison them.” (488) “According to the largest study ever

As we have seen, treatment of schizophrenia with antipsychotic drugs can have impressive results in terms of decreasing active symptoms, although it does nothing to alleviate negative symptoms or to improve cognitive functioning. Unfortunately, this kind of treatment has the drawback of extremely serious and even fatal side-effects. Newer generation atypical antipsychotics offer more hope, as they can treat both active and negative symptoms, and also improve cognitive functioning. Moreover, they have fewer side-effects. However, treatment is complicated by the fact that results are unpredictable; and in addition the side-effects that they do have can be very serious, such as diabetes, which in itself is life-threatening. However, as the potential side-effects are known, the physician has leeway to choose a drug which is a good match for the patient’s clinical profile. Then, once the patient’s symptoms have been much alleviated with an appropriate newer generation atypical antipsychotic, the patient should be able to also benefit from a range of psychotherapeutic interventions. It is argued that this is the best treatment regime to choose, as it is likely to result in the greatest improvement in quality of life, coupled with the lowest risk of potentially devastating side-effects, or of death. This is likely to be better than utilizing cognitive behavioral therapy, the results of which are not reliably known – although research has certainly shown that it is less efficacious

Current medications for dementia are limited and there is a need to explore traditional medicinal system to investigate the agents that can prevent progression of memory loss or improve the existing capacity of learning and memory. Thus present study was carried out to evaluate the effects of Ayurveda drug formulations, Tinospora cordifolia (Tc) & Phyllanthus emblica (Pe) with and without Ocimum sanctum (Os) on learning performance and memory of mice. We also tried to investigate the possible mechanisms of these plant drugs for their effects on learning and memory using Scopolamine, Diazepam and Cyclosporine as amnesic agents.

Antipsychotic – Psychotropic drugs are often used for neurochemical problems, behavioral problems, schizophrenia, and other mental disorders. These drugs sometimes cause side effects

During my first clinical rotation as a nursing student, I was assigned to care for several older adults suffering from dementia. Although all of my patients ranged in severity from mild to severe progression of dementia, they all experienced moments of agitation, anxiety, or disturbed behaviors related to their disease. It occurred to me after careful review of several patient charts that despite often being prescribed pharmaceutical regimes for other comorbidities, these patients were rarely prescribed medications, besides those to control anxiety, specifically targeted at treating their progressing dementia. Through some research I discovered that the significant number of individuals affected with dementia is a growing public health concern in part due to the current limited ability of pharmaceutical treatments to treat the disease (Samson, Clement, Narme, Schiaratura, & Ehrle, 2015). This revelation began my interest in current nonpharmacological treatments being implemented in controlling adverse behaviors and feelings in patients diagnosed with dementia.

2. The purpose of this study is to evaluate the efficacy and safety of low dose risperidone in treating psychosis of Alzheimer’s disease (AD) and mixed dementia (MD) in a subset of nursing-home residents who had dementia and aggression and who were participating in a randomized placebo-controlled trail of risperidone for aggression.