Which Organizational Characteristics Are Associated With Increased Management of Depression Using Antidepressants in US Nursing Homes

Bibliographic Data

ID9104840
AuthorsKate L Lapane (0000-0001-9957-7747, Brown University, corresponding author), Carmel Hughes (0000-0002-4656-6021, Queen's University Belfast), Carmel M Hughes
Year2004
Volume42
Issue10
Pages992-1000
Publication date2004-10-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/00005650-200410000-00008
PMID15377932
OpenAlexW2064464277
LanguageEN
Citations received6
References cited33

BACKGROUND: There is universal agreement that organizational characteristics of nursing facilities can and do influence the quality of care and resident outcomes. OBJECTIVE: This study evaluated the relation between organizational characteristics and management of depression using antidepressants. RESEARCH DESIGN: This was a cross-sectional study of Medicare/Medicaid certified nursing homes in 6 states in 2000. SUBJECTS: We studied 87,907 residents with depression in 2,128 facilities. MEASURES: Minimum Data Set (MDS) provided information regarding use of antidepressants and resident factors. On-line Survey and Certification of Automated Records (OSCAR) provided facility characteristics information including structural, resource, and staffing levels. Adjusted estimates of organizational effects on antidepressant drug use were derived from generalized estimating equations. RESULTS: Increased treatment of depression with antidepressants was associated with facilities with a higher percentage of residents from payer sources other than Medicare/Medicaid (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06) and more professional nursing staff (OR, 1.15; 95% CI, 1.05-1.26). Decreased treatment tended to be related to larger homes (OR, 0.76; 95% CI, 0.68-0.84) or if the home employed full-time physicians (OR, 0.87; 95% CI, 0.78-0.96). Once the decision to treat was made, treatment with tricyclics tended to be inversely related to larger homes, for-profit facilities, and homes with more Medicare residents. CONCLUSIONS: Facilities that are required to be more fiscally conservative, be it larger facilities with fewer private pay patients or for profit facilities, have lower rates of pharmacologic treatment. Resource and structural characteristics influence the type of antidepressant being prescribed; resident characteristics may not be the over-riding factor in prescribing

Case mix index · Certification · Confidence interval · Depression (economics) · Family medicine · Generalized estimating equation · Health care · Medicaid · Minimum Data Set · Nursing homes · Odds ratio · Psychiatry · Staffing · Dementia and Cognitive Impairment Research · Emergency Medicine · Geriatric Care and Nursing Homes · Internal Medicine · Medicine · Mental Health Treatment and Access · Nursing

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