• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (12)  • Contact me when this article is cited  Related Content  • Related letters  • Related articles  • Similar articles in this journal  Topic Collections  • Aging/ Geriatrics  • Neurology  • Dementias  • Psychiatry  • Psychopharmacology  • Cardiovascular System  • Quality of Care  • Patient Safety/ Medical Error  • Randomized Controlled Trial  • Arrhythmias  • Less Is More  • Comparative Effectiveness  • Drug Therapy  • Adverse Effects  • Drug Therapy, Other  • Congestive Heart Failure/ Cardiomyopathy  • Alert me on articles by topic  Social Bookmarking   What's this?

Yong Chen, MD, MHS; Becky A. Briesacher, PhD; Terry S. Field, DSc; Jennifer Tjia, MD; Denys T. Lau, PhD; Jerry H. Gurwitz, MD

Arch Intern Med. 2010;170(1):89-95.

Background  Serious safety concerns related to the use of antipsychotics have not decreased the prescribing of these agents to nursing home (NH) residents. We assessed the extent to which resident clinical characteristics and institutional prescribing practice were associated with antipsychotic prescribing.

Methods  Antipsychotic prescribing was assessed for a nationwide, cross-sectional population of 16 586 newly admitted NH residents in 2006. We computed facility-level antipsychotic rates based on the previous year's (2005) prescribing patterns. Poisson regressions with generalized estimating equations were used to identify the likelihood of resident-level antipsychotic medication use in 2006, given 2005 facility-level prescribing pattern and NH resident indication for antipsychotic therapy (psychosis, dementia, and behavioral disturbance).

Results  More than 29% (n = 4818) of study residents received at least 1 antipsychotic medication in 2006. Of the antipsychotic medication users, 32% (n = 1545) had no identified clinical indication for this therapy. Residents entering NHs with the highest facility-level antipsychotic rates were 1.37 times more likely to receive antipsychotics relative to those entering the lowest prescribing rate NHs, after adjusting for potential clinical indications (risk ratio [RR], 1.37; 95% confidence interval [CI], 1.24-1.51). The elevated risk associated with facility-level prescribing rates was apparent for only NH residents with dementia but no psychosis (RR, 1.40; 95% CI, 1.23-1.59) and residents without dementia or psychosis (RR, 1.54; 95% CI, 1.24-1.91).

Conclusions  The NH antipsychotic prescribing rate was independently associated with the use of antipsychotics in NH residents. Future research is needed to determine why such a prescribing culture exists and whether it could result in adverse health consequences.

Author Affiliations: Division of Geriatric Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester (Drs Chen, Briesacher, Field, Tjia, and Gurwitz); and Department of Medicine and Buehler Center on Aging, Health & Society, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Dr Lau).

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Variations in Antipsychotic Prescribing in Nursing Homes: Can This Be Reflective of Referral Patterns?
Glen L. Xiong and Y. Pritham Raj
Arch Intern Med. 2010;170(10):917-918.
EXTRACT | FULL TEXT  

Variations in Antipsychotic Prescribing in Nursing Homes: Can This Be Reflective of Referral Patterns?—Reply
Yong Chen, Becky A. Briesacher, Terry S. Field, Jennifer Tjia, Denys T. Lau, and Jerry H. Gurwitz
Arch Intern Med. 2010;170(10):918.
EXTRACT | FULL TEXT  

RELATED ARTICLES

In This Issue of Archives of Internal Medicine
Arch Intern Med. 2010;170(1):5.
FULL TEXT  

The Influence of Nursing Home Culture on the Use of Feeding Tubes
Ruth Palan Lopez, Elaine J. Amella, Neville E. Strumpf, Joan M. Teno, and Susan L. Mitchell
Arch Intern Med. 2010;170(1):83-88.
ABSTRACT | FULL TEXT  

Impact of FDA Black Box Advisory on Antipsychotic Medication Use
E. Ray Dorsey, Atonu Rabbani, Sarah A. Gallagher, Rena M. Conti, and G. Caleb Alexander
Arch Intern Med. 2010;170(1):96-103.
ABSTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Comparison of Different Approaches to Confounding Adjustment in a Study on the Association of Antipsychotic Medication With Mortality in Older Nursing Home Patients
Huybrechts et al.
Am J Epidemiol 2011;174:1089-1099.
ABSTRACT | FULL TEXT  

Associated factors with antipsychotic use in assisted living facilities: a cross-sectional study of 4367 residents
Larrayadieu et al.
Age Ageing 2011;40:368-375.
ABSTRACT | FULL TEXT  

Variations in Antipsychotic Prescribing in Nursing Homes: Can This Be Reflective of Referral Patterns?
Xiong and Raj
Arch Intern Med 2010;170:917-918.
FULL TEXT  

Variations in Antipsychotic Prescribing in Nursing Homes: Can This Be Reflective of Referral Patterns?--Reply
Chen et al.
Arch Intern Med 2010;170:918-918.
FULL TEXT  

Less Is More
Redberg
Arch Intern Med 2010;170:584-584.
FULL TEXT  

Changing the Culture of Nursing Homes: The Physician's Role
Johnson
Arch Intern Med 2010;170:407-409.
FULL TEXT