Ensuring access to new medications in long-term care (LTC) facilities remains a critical and underexplored challenge in geriatric healthcare. While advancements in pharmaceutical research and therapeutic alternatives offer significant benefits to the aging population, the practical implementation of these innovations within LTC environments often faces systemic obstacles. As the population of older adults expands, the need for effective and safe pharmacological treatments becomes increasingly urgent. Significant disparities in access to medications, influenced by factors such as age and ethnicity, affect the probability of receiving newer treatments (Medlinskiene et al., 2021). The distinct challenges encountered by LTC residents, including multimorbidity and polypharmacy, further complicate medication use and management.
Key Objectives
- Describe Variation in Treatment Rates: Analyze the treatment rates for ten common chronic conditions.
- Identify Relationships: Begin to identify potential relationships between treatment, demographic, and clinical characteristics. Evaluate disparities in access based on demographic and clinical characteristics.
Research Overview
The population data for this research initiative is derived from PointClickCare Life Sciences’ deidentified electronic health records (EHRs) of LTC residents across the United States with a documented diagnosis between January 1 and April 1, 2025.
Understanding treatment patterns in LTC settings is crucial for improving patient outcomes and ensuring effective medication management. Our study aims to address this by analyzing deidentified EHR data to describe treatment frequency for ten chronic conditions. By integrating these historical and contemporary data sources, we aim to contribute to the development of evidence-based guidelines and strategies that enhance the quality of care for LTC residents.
Methodology
We used a structured review of medication binders aligned with clinical guidelines to ensure consistency in treatment mapping. We are reviewing these binders with regard to prescribing guidelines for the conditions to map the treatment landscape accurately, ensuring precise data for our research.
Residents were categorized by demographic and clinical characteristics. Pharmacologic treatment was defined as an active order for any diagnosis-related medication, grouped by function and age (novel, new, established). Treatment rates were calculated by diagnosis subtype and medication category.
Future/Ongoing Research Initiatives
Alzheimer’s Disease and Related Dementias (ADRD) Retrospective Cohort Study
This study will concentrate on ADRD. This retrospective cross-sectional study analyzed deidentified EHR data from 435,406 LTC residents across the U.S. with a documented ADRD diagnosis between January 1 and April 1, 2025. Residents were categorized by demographic and clinical characteristics. Pharmacologic treatment was defined as an active order for any ADRD-related medication, grouped by function (cognitive, behavioral, disease-modifying) and age (novel, new, established). Treatment rates were calculated by ADRD subtype and medication category.
The primary objectives were to characterize pharmacologic treatment patterns for ADRD in LTC settings and quantify treatment rates by dementia subtype, medication class, and function using real-world EHR data.
Diabetes Retrospective Cohort Study
This retrospective cohort study will examine diabetes management in LTC settings. This retrospective cross-sectional study analyzed deidentified EHR data from 540,466 LTC residents across the United States with a documented diabetes diagnosis between January 1 and April 1, 2025. Residents were categorized by demographic and clinical characteristics. Pharmacologic treatment was defined as the presence of an active order for any diabetes-related medication. Medications were grouped by class (e.g., insulin, biguanides, sulfonylureas, GLP-1 receptor agonists, SGLT-2 inhibitors), function (e.g., regulate blood sugar, treat high blood sugar), and age (established, new, novel). Treatment rates were calculated by diabetes subtype and medication category.
The aim is to determine whether the adoption of new diabetes medications (GLP-1s and SGLT-2s) is in accordance with the 2022 guidelines established by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Additionally, it will evaluate the uptake of these medications among U.S. adults with type 2 diabetes by 2025, utilizing PointClickCare EHR data. The primary objectives were to characterize pharmacologic treatment patterns for Diabetes in LTC settings and quantify treatment rates by diabetes subtype, medication class, and function using real-world EHR data.
Multichronicity and Polypharmacy
Multichronicity and polypharmacy introduce clinical uncertainty, often deterring prescribers from initiating newer therapies despite potential benefits.
The presence of multiple chronic conditions complicates the management and administration of new medications. More complexity may lead to greater uncertainty surrounding prescribing and ultimately contribute to lower treatment rates. The lack of evidence-based guidelines tailored to individuals with multiple chronic conditions exacerbates these challenges and further motivates our research into this area.
Polypharmacy, defined as the simultaneous administration of several medications, is a common occurrence for older adults residing in LTC facilities. This situation may complicate the integration of new therapeutic interventions and heighten the likelihood of adverse drug reactions (Hagiwara et al., 2024; Wang et al., 2018). Many residents in LTC facilities are historically excluded from clinical trials, resulting in a lack of evidence-based guidelines tailored to their specific requirements, thereby exacerbating challenges in medication management (Sluggett et al., 2024).
Lack of Information on Barriers
The lack of information on barriers for prescribing in LTC settings, and associated population features like age-related barriers, multiple chronic conditions, polypharmacy, and the newness of medications, motivates our research initiative. This knowledge gap underscores the urgency for targeted research that informs policy and practice. By integrating historical and contemporary data sources, we aim to contribute to the development of evidence-based guidelines and strategies that enhance the quality of care for long-term care residents.
Resources and References
- Wagner, B., Arora, T. (2025). Medication Use for Chronic Conditions in Long-Term Care. Poster abstract submitted (under review) to the AMIA Annual Symposium, Atlanta, GA. Submitted at: AMIA 2025 Annual Symposium
- Hagiwara, S., Komiyama, J., Iwagami, M., Hamada, S., Komuro, M., Kobayashi, H., & Tamiya, N. (2024). Polypharmacy and potentially inappropriate medications in older adults who use long-term care services: A cross-sectional study. BMC Geriatrics, 24(1), 696. https://doi.org/10.1186/s12877-024-05296-4
- Lublóy, Á. (2014). Factors affecting the uptake of new medicines: A systematic literature review. BMC Health Services Research, 14(1), 469. https://doi.org/10.1186/1472-6963-14-469
- Medlinskiene, K., Tomlinson, J., Marques, I., Richardson, S., Stirling, K., & Petty, D. (2021). Barriers and facilitators to the uptake of new medicines into clinical practice: A systematic review. BMC Health Services Research, 21(1), 1198. https://doi.org/10.1186/s12913-021-07196-4
- Pandya, N., Jung, M., Norfolk, A., Goldblatt, C., Trenery, A., & Sieradzan, R. (2023). Medication prescribing for type 2 diabetes in the US long-term care setting: Observational study. Journal of the American Medical Directors Association, 24(6). https://doi.org/10.1016/j.jamda.2023.03.020
- Sluggett, J. K., Inacio, M. C., & Caughey, G. E. (2024). Medication management in long-term care: Using evidence generated from real-world data to effect policy change in the Australian setting. American Journal of Epidemiology, 193(12), 1645–1649. https://doi.org/10.1093/aje/kwae136
- Effective Health Care Program. (n.d.). Treatment of dementia among community-dwelling and institutionalized Medicare beneficiaries. Agency for Healthcare Research and Quality. https://effectivehealthcare.ahrq.gov/
