Antipsychotic use in nursing homes varies by psychiatric consultant
Department of Medicine, Division of Geriatric Medicine; Meyers Primary Care Institute
Aged; Antipsychotic Agents; Consultants; Cross-Sectional Studies; Drug Utilization; Female; Homes for the Aged; Humans; Inappropriate Prescribing; Male; Middle Aged; Nursing Homes; Physician's Practice Patterns; Prevalence; Psychiatry; Quality of Health Care
Chemical Actions and Uses | Geriatrics | Health Services Administration | Psychiatric and Mental Health | Psychiatry | Therapeutics
BACKGROUND: The relationship between psychiatric consultation and antipsychotic prescribing in nursing homes (NH) is unknown.
OBJECTIVE: To identify the association between psychiatric consultant groups and NH-level antipsychotic prescribing after adjustment for resident case-mix and facility characteristics.
RESEARCH DESIGN AND SUBJECTS: Nested cross-sectional study of 60 NHs in a cluster randomized trial. We linked facility leadership surveys to October 2009-September 2010 Minimum Data Set, Nursing Home Compare, the US Census, and pharmacy dispensing data.
MEASURES: The main exposure is the psychiatric consultant group and the main outcome is NH-level prevalence of atypical antipsychotic use. We calculated annual means and interquartile ranges of NH-level antipsychotic use for each consultant group and arrayed consultant groups from lowest to highest prevalence. Generalized linear models were used to predict antipsychotic prescribing adjusting for resident case-mix and facility characteristics. Observed versus predicted antipsychotic prescribing levels were compared for each consultant group.
RESULTS: Seven psychiatric consultant groups served a range of 3-27 study facilities. Overall mean facility-level antipsychotic prescribing was 19.2%. Mean prevalence of antipsychotic prescribing ranged from 12.2% (SD, 5.8) in the lowest consultant group to 26.4% (SD, 3.6) in the highest group. All facilities served by the highest-ranked consultant group had observed antipsychotic levels exceeding the overall study mean with half exceeding predictions for on-label indications, whereas most facilities served by the lowest-ranked consultant group had observed levels below the overall study and predicted means.
CONCLUSIONS: Preliminary evidence suggests that psychiatric consultant groups affect NH antipsychotic prescribing independent of resident case-mix and facility characteristics.
DOI of Published Version
Med Care. 2014 Mar;52(3):267-71. doi: 10.1097/MLR.0000000000000076. Link to article on publisher's site
Tjia J, Field TS, Lemay CA, Mazor KM, Pandolfi M, Spenard A, Ho S, Kanaan AO, Donovan JL, Gurwitz JH, Briesacher BA. (2014). Antipsychotic use in nursing homes varies by psychiatric consultant. Meyers Primary Care Institute Publications. https://doi.org/10.1097/MLR.0000000000000076. Retrieved from https://escholarship.umassmed.edu/meyers_pp/701