Changes in antipsychotic drug use in nursing homes during implementation of the OBRA-87 regulations
Changes in antipsychotic drug use in nursing homes during implementation of the OBRA-87 regulations
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DOI：
10.1001/jama.271.5.358
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发表时间：
1994-01-01
期刊：
影响因子：
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通讯作者：
Ray, Wayne A.
中科院分区：
文献类型：
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作者：
Shorr, Ronald I.;Fought, Randy L.;Ray, Wayne A.
目标：描述旨在减少不必要使用的联邦立法（1987 年综合预算协调法案 (OBRA-87)）实施期间疗养院抗精神病药物使用的变化，并确定与此类变化相关的疗养院特征。设计：对 9432 名 65 岁或以上的田纳西州医疗补助参与者进行纵向研究，这些参与者从 1989 年 4 月 1 日到 1991 年 9 月 30 日（围绕实施 OBRA-87 的 30 个月期间）持续居住在田纳西州。主要结果指标：抗精神病药和其他精神药物的使用发生变化。结果 - 在 30 个月期间，抗精神病药物的使用从每 100 天居住 23.9 天减少到 17.5 天，下降了 26.7% (P < .001)，这是由于新使用者的减少 (P <.001) 和长期使用抗精神病药物的减少 (P <.001) 造成的。其他精神药物的使用没有随之增加。多变量分析显示，抗精神病药物使用的变化与基线抗精神病药物使用 (P=.001) 和三班人员配置水平 (P=.003) 密切相关。基线抗精神病药物使用和三班人员配置高于中位数的疗养院抗精神病药物使用量减少了 41%，而这两个因素都低于中位数的疗养院则增加了 2% (P < .0001)。结论：-抗精神病药物使用量大幅减少与 OBRA-87 的实施同时发生。尽管这种下降与疗养院护理质量的提高是一致的，但仍需要进一步研究来确定该立法对居民结果的影响。
Objectives.-To describe the changes in antipsychotic drug use in nursing homes during the period surrounding the implementation of federal legislation designed to reduce unnecessary use (the Omnibus Budget Reconciliation Act of 1987 (OBRA-87)) and to identify nursing home characteristics associated with such changes. Design.-Longitudinal study of 9432 Tennessee Medicaid enrollees 65 years of age or older who continuously resided in Tennessee from April 1, 1989, to September 30,1991, a 30-month period surrounding implementation of OBRA-87. Main Outcome Measures.-Changes in the use of antipsychotic and other psychotropic drugs. Results.-During the 30-month period, antipsychotic drug use decreased from 23.9 to 17.5 days per 100 days of residence, a 26.7% decline (P lt .001), which resulted from both a decrease in new users (P lt .001) and a reduction in long-term use of antipsychotic drugs (P lt .001). There was no concomitant increase in other psychotropic drug use. A multivariate analysis revealed that changes in antipsychotic use were strongly associated with baseline antipsychotic use (P=.001) and third-shift staffing levels (P=.003). Nursing homes with baseline antipsychotic drug use and third-shift staffing above the median reduced antipsychotic drug use by 41%, compared with a 2% increase in nursing homes where both of these factors were below the median (P lt .0001). Conclusions.-A substantial decrease in antipsychotic drug use coincided with the implementation of OBRA-87. Although this decrease is consistent with an improvement in quality of nursing home care, further research is needed to determine the effects of this legislation on resident outcomes.