Rates of antipsychotic drug prescribing for dementia climbed during the pandemic

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Rates of antipsychotic drug prescribing among people with dementia increased substantially in six high-income countries during the initial months of the pandemic and remained elevated through 2021, researchers reported yesterday in JAMA Psychiatry.

To examine trends in antipsychotic drug prescribing among people with dementia before and during the pandemic, a team led by researchers from the University of Hong Kong analyzed electronic health record and claims data from eight databases in Germany, France, Italy, South Korea, the United Kingdom, and the United States from 2016 through November 2021. The study included all patients aged 65 years and older who had a diagnosis of dementia, and 365 days of observation, within the study period.

The study identified a total of 857,238 people (58% female) with a diagnosis of dementia. Although reductions were observed in the incidence of dementia and the total number of people with dementia prescribed antipsychotic drugs in the early phase of the pandemic in all countries except Germany, rates of antipsychotic drug prescribing for people with dementia increased markedly in six databases representing all countries.

Notably, the antipsychotic drug prescribing rates at the latest available months in 2021 were still among the highest compared with previous years.

Compared with the corresponding month in 2019, the most pronounced increase was observed in May 2020 in South Korea (rate ratio [RR], 2.11; 95% confidence interval [CI], 1.47 to 3.02) and June 2020 in the United Kingdom (RR, 1.96; 95% CI, 1.24 to 3.09).

The rates of antipsychotic drug prescribing in these six databases remained high in 2021. Interrupted time series analyses revealed immediate increases in the prescribing rate in Italy (RR, 1.31; 95% CI, 1.08 to 1.58) and in the US Medicare database (RR, 1.43; 95% CI, 1.20 to 1.71) after the introduction of COVID-19 restrictions.

"Notably, the antipsychotic drug prescribing rates at the latest available months in 2021 were still among the highest compared with previous years," the study authors wrote. "This suggests that the burden of unmet needs in people living with dementia was substantial and that this population faced continued challenges in care even after the acute phase of the COVID-19 pandemic."

New York to expand its wastewater surveillance network

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Chris Dall, MA

The New York State Department of Health (NYSDOH) announced earlier this week that it has received more than $21 million in funding to expand its wastewater surveillance and infectious disease monitoring capabilities.

The $21.6 million in funding, which includes a $6.6 million grant from the Centers for Disease Control and Prevention, will help NYSDOH launch new pilot programs through its Wastewater Surveillance Network to test for influenza, respiratory syncytial virus, hepatitis A, norovirus, and antimicrobial-resistance genes. The number of participating watersheds in the network, which was established in August 2021 to help support the state's COVID-19 response, will grow from 125 to 215 and cover 81% of the population served by public sewer systems in the state.

In addition to enabling advanced tracking of COVID-19, the network helped NYSDOH detect poliovirus in wastewater following the identification of a case of paralytic polio in Rockland County in July 2022. State health officials say expanding the network to look for other threats will give NYSDOH and local health departments advance warning for early intervention strategies.

"Providing confidential, science-based and community-level information, wastewater monitoring is advancing our tracking of trends for COVID-19 and has been invaluable in identifying polio in communities," acting State Health Commissioner James McDonald, MD, MPH, said in a press release. "These resources directly expand our wastewater monitoring network—and its reach—giving our team additional proactive capabilities to protect and promote the health of New Yorkers against more health threats."

Researchers develop tool to assess antibiotic resistance knowledge

News brief

Chris Dall, MA

A team of researchers from the London School of Hygiene and Tropical Medicine have developed a tool that they say can reliably assess awareness of antibiotic resistance (ABR) among human and animal healthcare professionals.

In a study published today in the Journal of Antimicrobial Chemotherapy, the researchers describe the design, testing, and analysis of a self-administered questionnaire that included an ABR awareness module with 23 items under four domains: mechanisms of ABR, antibiotic use as a driver of resistance, transmission and infection control of ABR, and detection and recognition of ABR. The questionnaire was completed by human and animal healthcare professionals trained to prescribe and dispense antibiotics in Ghana, Nigeria, Tanzania, Vietnam, Thailand, and Peru.

Overall, 941 healthcare professionals (625 human and 316 animal) were included in the study. Median ABR awareness scores were 54.6 to 63.5 for human healthcare professional and 55.2 to 63.8 for animal healthcare professionals (on a scale of 0 to 100). Physicians and veterinarians scored higher than other healthcare professionals in every country tested.

Around two thirds of respondents felt the information they received on ABR was not adequate to inform their day-to-day practice, and most respondents felt they had inadequate access to local ABR patterns. More than 95% of human healthcare professionals said they were interested in receiving information or training on ABR and antimicrobial stewardship.

The study authors note that while better ABR awareness levels may not necessarily correlate with better antibiotic prescribing practices, they are a prerequisite for the success of behavioral interventions around antibiotic use, and therefore it is "crucial to design a tool that enables such a measurement."

"This tool could be used to direct and track interventions to improve [antimicrobial resistance] awareness and to ascertain the success of these interventions, enabling cost-effectiveness evaluations," they wrote.