Chronic benzodiazepine use in nursing homes: effects of federal guidelines, resident mix, and nurse staffing.
Chronic benzodiazepine use in nursing homes: effects of federal guidelines, resident mix, and nurse staffing.
复制标题
疗养院中长期使用苯二氮卓类药物：联邦指南、居民组合和护士人员配置的影响。
DOI：
10.1046/j.1532-5415.2001.t01-1-49278.x
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发表时间：
2001
影响因子：
6.3
通讯作者：
Mount,JK
中科院分区：
文献类型：
--
作者：
Svarstad,BL;Mount,JK
注意事项：评估在卫生保健财务管理局（HCFA）实施BZ指南之前和之后，养老院中苯二氮卓类药物（BZ）的总体处方和长期使用情况。第二个目的是确定设施的预测BZ处方和长期使用指南implementation.DESIGN：Nonexperimental，观察性研究design.SETTING：药物使用进行了评估，在16个随机选择的熟练护理设施在威斯康星州1990年之前，并再次在1993-1994.PARTICIPANTS：1181医疗补助资助的居民在基线和1,650医疗补助资助的居民在follow-up.MEASUREMENTS：药物使用措施包括居民处方BZ的百分比和居民与慢性BZ使用（定义为≥4个月的连续使用）的百分比。使用4个月的截止时间，因为HCFA指南认为该持续使用时间可能过长。药物使用的设施预测因素包括居民人口统计学和诊断组合，大小，所有权，每日医疗补助，和nurse staffing.RESULTS：在1990年之前，四分之一的所有居民被规定BZ和近十分之一的所有居民有慢性BZ使用。联邦指南对这些指标无显著影响; BZ处方仅下降3.6%（26.4-22.8%），长期使用仅下降1.3%（9.2-7.9%）。回归结果显示，随访时女性住院医师较多（β = 0.52，P = 0.018）和精神疾病住院医师较多（β = 0.41，P = 0.045）的医疗机构的总体处方量较高。然而，护士配备是慢性BZ使用的唯一重要预测因素。正如预期的那样，更好的护士配备与较低的慢性使用率相关（β = − 0. 46，P = 0. 037）.结论：改善养老院BZ使用的努力必须解决更好的护士配备和更好的评估和管理可能触发BZ处方的精神疾病的需求。
OBJECTIVES:To assess the overall prescribing and chronic use of benzodiazepines (BZs) in nursing homes before and after implementation of BZ guidelines by the Health Care Finance Administration (HCFA). A second aim was to identify facility predictors of BZ prescribing and chronic use after guideline implementation.DESIGN:Nonexperimental, observational study design.SETTING:Drug use was assessed in 16 randomly selected skilled nursing facilities in Wisconsin before 1990 and again in 1993–1994.PARTICIPANTS:One thousand one hundred eighty‐one Medicaid‐funded residents at baseline and 1,650 Medicaid‐funded residents at follow‐up.MEASUREMENTS:Drug use measures included percentage of residents with prescribed BZs and percentage of residents with chronic BZ use (defined as ≥4 months of continuous use). A 4‐month cutoff was used because HCFA guidelines consider this length of continuous use to be potentially excessive. Facility predictors of drug use included resident demographic and diagnostic mix, size, ownership, Medicaid per diem, and nurse staffing.RESULTS:Before 1990, one‐fourth of all residents were prescribed a BZ and nearly one‐tenth of all residents had chronic BZ use. Federal guidelines had nonsignificant effects on these measures; BZ prescribing declined only 3.6% (26.4–22.8%) and chronic use declined only 1.3% (9.2–7.9%). Regression results showed that overall prescribing at follow‐up was higher in facilities with more female residents (β = .52,P= .018) and residents with psychiatric disorders (β = .41,P= .045). However, nurse staffing was the only significant predictor of chronic BZ use. As expected, better nurse staffing was associated with lower rates of chronic use (β = −0.46,P= .037).CONCLUSION:Efforts to improve BZ use in nursing homes must address the need for better nurse staffing and better assessment and management of psychiatric disorders that can trigger BZ prescribing.