Psychoactive Medication Prescribing After Critical Illness in American Adults Not Justified by a Documented Supporting Diagnosis
Ting Ting Wu, O. Joseph Bienvenu, Louisa H. Smith, Jane S. Saczynski, Robert Cavanaugh, John W. DevlinObjectives:
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.