PRP081: Successes and lessons learned: nursing home dementia symptom management since COVID-19 in Virginia.
John Kerns, MD; Jonathan Winter, MD; Christian Bergman; Rebecca Etz, PhD
Abstract
CONTEXT: A significant number of Virginia long-term care facilities (LTCF) still rely heavily on dangerous drugs to manage dementia symptoms. Pilot data indicate that COVID stressors have made dementia symptom management more difficult. LTCF clinician explanations for shifts in drug and non-medication dementia management strategies due to COVID and other ongoing recent challenges is unknown.
OBJECTIVE: To examine what Virginia LTCF clinicians report via comments and open-ended survey questions regarding why changes in dementia management may have occurred since COVID in Virginia LTCF, closely examining successes and lessons learned.
STUDY DESIGN: An iterative online survey of a sample of Virginia LTCF providers purposefully chosen to include clinicians in areas of poor social determinants of health (SDH) known to correlate with higher prevalence’s of antipsychotic use. Open-ended questions and comments analyzed in an ongoing exploratory fashion via a combination of template analysis, editing, and immersion and crystallization. Initial survey questions and codes derived from previous studies of dementia management in Virginia, input from statewide geriatric and LTCF organizational partners helping to develop and field the surveys, and our clinical experience managing dementia symptoms. Codes and survey questions honed/expanded iteratively to include emergent findings from participant responses and suggestions from our partners.
PARTICIPANTS: Physicians, nurse practitioners, physician assistants, psychiatrists, other prescribing clinicians managing dementia in Virginia LTCF.
OUTCOMES: Reasons for LTCF drug and non-drug dementia management choices/availability and disparities in care since COVID, as reported by Virginia LTCF clinicians. Analysis emphasis on successes, lessons learned, and evaluation of potential differences related to provider type and SDH.
RESULTS: Clinician identified reasons for changes in drug use and other management of dementia symptoms during COVID, delineating achievements as well as barriers. Similarities/differences by clinician type and SDH.
CONCLUSIONS: LTCF have largely borne the brunt of the COVID pandemic. Identifying recent successes and ongoing challenges in management of dementia symptoms, possibly magnified in areas of low SDH, can inform policy makers, and could point to proven interventions as well as needed resource supports to address any SDH disparities detected.
OBJECTIVE: To examine what Virginia LTCF clinicians report via comments and open-ended survey questions regarding why changes in dementia management may have occurred since COVID in Virginia LTCF, closely examining successes and lessons learned.
STUDY DESIGN: An iterative online survey of a sample of Virginia LTCF providers purposefully chosen to include clinicians in areas of poor social determinants of health (SDH) known to correlate with higher prevalence’s of antipsychotic use. Open-ended questions and comments analyzed in an ongoing exploratory fashion via a combination of template analysis, editing, and immersion and crystallization. Initial survey questions and codes derived from previous studies of dementia management in Virginia, input from statewide geriatric and LTCF organizational partners helping to develop and field the surveys, and our clinical experience managing dementia symptoms. Codes and survey questions honed/expanded iteratively to include emergent findings from participant responses and suggestions from our partners.
PARTICIPANTS: Physicians, nurse practitioners, physician assistants, psychiatrists, other prescribing clinicians managing dementia in Virginia LTCF.
OUTCOMES: Reasons for LTCF drug and non-drug dementia management choices/availability and disparities in care since COVID, as reported by Virginia LTCF clinicians. Analysis emphasis on successes, lessons learned, and evaluation of potential differences related to provider type and SDH.
RESULTS: Clinician identified reasons for changes in drug use and other management of dementia symptoms during COVID, delineating achievements as well as barriers. Similarities/differences by clinician type and SDH.
CONCLUSIONS: LTCF have largely borne the brunt of the COVID pandemic. Identifying recent successes and ongoing challenges in management of dementia symptoms, possibly magnified in areas of low SDH, can inform policy makers, and could point to proven interventions as well as needed resource supports to address any SDH disparities detected.
Nadir
11/19/2021This is great. Thank you