Antipsychotic Use in Nursing Homes Varies by Psychiatric Consultant

Bibliographic Data

ID9098576
AuthorsJennifer Tjia (0000-0003-4541-0460, University of Massachusetts Chan Medical School, corresponding author), Terry S Field (0000-0002-4990-8357, University of Massachusetts Chan Medical School, corresponding author), Terry Field, Celeste Lemay, Celeste A Lemay (University of Massachusetts Chan Medical School, corresponding author), Kathleen M Mazor (0000-0002-9491-9872, University of Massachusetts Chan Medical School, corresponding author), Kathleen Mazor, Michelle Pandolfi, Michelle M Pandolfi (0000-0003-1758-8122, Qualidigm (United States)), Ann Spenard (Qualidigm (United States)), Shih-Yieh Ho, Shih‐Yieh Ho (Qualidigm (United States)), Abir Kanaan, Abir O Kanaan (0000-0003-0330-095X, University of Massachusetts Chan Medical School, corresponding author), Jennifer L Donovan (0000-0002-3106-7676, MCPHS University, corresponding author), Jennifer Donovan, Jerry H Gurwitz (0000-0003-1630-8213, University of Massachusetts Chan Medical School, corresponding author), Becky A Briesacher (0000-0002-0401-1685, University of Massachusetts Chan Medical School, corresponding author), Becky Briesacher
Year2014
Volume52
Issue3
Pages267-271
Publication date2014-03-01
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000076
PMID24374410
PMCIDPMC3948216
OpenAlexW2046919599
LanguageEN
References cited9

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

Antipsychotic · Family medicine · Interquartile range · Minimum Data Set · Nursing homes · Psychiatry · Schizophrenia (object-oriented programming) · Geriatric Care and Nursing Homes · Internal Medicine · Medicine · Nursing · Psychiatric care and mental health services · Schizophrenia research and treatment

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