title: Antipsychotic medication utilization in nonpsychiatric hospitalizations.
abstract: Although antipsychotics are used for treatment of delirium/agitation in hospitalized patients, their scope of use has not been investigated in a large, multicenter cohort.
  
  
  
  To determine rates of use and hospital variation in use of antipsychotics in nonpsychiatric admissions.
  
  
  
  Cohort study of adult, nonpsychiatric admissions to 300 US hospitals contributing data to the Premier database, from July 1, 2009 to June 30, 2010.
  
  
  
  Antipsychotic exposure defined using pharmacy charges. Potentially excessive dosing defined using guidelines for long-term care facilities.
  
  
  
  Our cohort included 2,695,081 admissions (median age, 63 years; 56% female). Antipsychotic exposure occurred in 160,773 (6%) admissions; 102,148 (64%) received atypical antipsychotics, 76,979 (48%) received typical, and 18,354 (11%) received both. Among exposed admissions, 47% received ≥1 potentially excessive daily dose. Among the variables we analyzed, the strongest predictors of antipsychotic receipt were delirium (relative risk [RR]: 2.93, 95% CI: 2.88-2.98) and dementia (RR: 2.78, 95% CI: 2.72-2.83). After adjustment for patient characteristics, patients admitted to hospitals in the highest antipsychotic prescribing quintile were more than twice as likely to be exposed compared to patients admitted to hospitals in the lowest prescribing quintile (RR: 2.56, 95% CI: 2.50-2.61). This relationship was similar across subgroups of admissions with delirium and dementia.
  
  
  
  Antipsychotic medication exposure is common in nonpsychiatric admissions to US hospitals. The observed variation in antipsychotic prescribing was not fully explained by measured patient characteristics, suggesting the possibility of differing hospital prescribing cultures. Additional research and guidelines are necessary to define appropriate use of these potentially harmful medications in the hospital setting. Journal of Hospital Medicine 2016;11:543-549. © 2016 Society of Hospital Medicine.
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.
authors.forename: Shoshana J
authors.initials: SJ
authors.lastname: Herzig
authors.affiliation: Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Jamey R
authors.initials: JR
authors.lastname: Guess
authors.affiliation: Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.|University of Massachusetts Medical School, Worcester, Massachusetts.
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts.|Harvard Medical School, Boston, Massachusetts.|Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003693:Delirium / Q000188:drug therapy; D003704:Dementia / Q000188:drug therapy; D017723:Drug Utilization Review; D005260:Female; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies
chemical_list: D014150:Antipsychotic Agents