Unexplained Variation Across US Nursing Homes in Antipsychotic Prescribing Rates
Unexplained Variation Across US Nursing Homes in Antipsychotic Prescribing Rates
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DOI：
10.1001/archinternmed.2009.469
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发表时间：
2010-01-11
影响因子：
--
通讯作者：
Gurwitz, Jerry H.
中科院分区：
文献类型：
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作者：
Chen, Yong;Briesacher, Becky A.;Gurwitz, Jerry H.
背景资料：与使用抗精神病药物相关的严重安全性问题并未减少这些药物对疗养院（NH）居民的处方。我们评估的程度，居民的临床特征和机构处方的做法与antipsychotic prescribing.Methods：抗精神病药物处方进行了评估，为全国范围内，横断面人口16 586新入院的NH居民在2006年。我们根据前一年（2005年）的处方模式计算了机构水平的抗精神病药使用率。泊松回归广义估计方程被用来确定的可能性，居民水平的抗精神病药物的使用在2006年，2005年设施级处方模式和NH居民的抗精神病药物治疗（精神病，痴呆症，行为障碍）的适应症。结果：超过29%（n=4818）的研究居民在2006年收到至少I抗精神病药物。在抗精神病药物使用者中，32%（n = 1545）没有确定的临床适应症。在调整潜在的临床适应症后，进入设施水平抗精神病药物使用率最高的国家卫生院的居民接受抗精神病药物的可能性是进入处方率最低的国家卫生院的居民的1.37倍（风险比[RR]，1.37; 95%置信区间[CI]，1.24-1.51）。与设施水平处方率相关的风险升高仅在患有痴呆但无精神病的NH居民（RR，1.40; 95%CI，1.23-1.59）和没有痴呆或精神病的居民（RR，1.54; 95%CI，1.24-1.91）中明显。结论：NH抗精神病药物处方率与NH居民使用抗精神病药物独立相关。未来的研究需要确定为什么存在这样的处方文化，以及它是否会导致不良的健康后果。
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 I 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% Cl, 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.