Center for Gerontology & Health Care Research, The Warren Alpert Medical School, Brown University, Providence, RI 02903, USA.
Int J Geriatr Psychiatry. 2009 Oct;24(10):1110-8. doi: 10.1002/gps.2232.
This study compares inter- and intra-country differences in the prevalence of physical restraints and antipsychotic medications in nursing homes, and examines aggregated resident conditions and organizational characteristics correlated with these treatments.
Population-based, cross-sectional data were collected using a standardized Resident Assessment Instrument (RAI) from 14,504 long-term care facilities providing nursing home level services in five countries participating in the interRAI consortium, including Canada, Finland, Hong Kong (Special Administrative Region, China), Switzerland, and the United States. Facility-level prevalence rates of physical restraints and antipsychotic use were examined both between and within the study countries.
The prevalence of physical restraint use varied more than five-fold across the study countries, from an average 6% in Switzerland, 9% in the US, 20% in Hong Kong, 28% in Finland, and over 31% in Canada. The prevalence of antipsychotic use ranged from 11% in Hong Kong, between 26-27% in Canada and the US, 34% in Switzerland, and nearly 38% in Finland. Within each country, substantial variations existed across facilities in both physical restraint and antipsychotic use rates. In all countries, neither facility case mix nor organizational characteristics were particularly predictive of the prevalence of either treatment.
There exists large, unexplained variability in the prevalence of physical restraint and antipsychotic use in nursing home facilities both between and within countries. Since restraints and antipsychotics are associated with adverse outcomes, it is important to understand the idiosyncratic factors specific to each country that contribute to variation in use rates.
本研究比较了国家间和国家内护理院中身体约束和抗精神病药物使用的流行率，并探讨了与这些治疗方法相关的综合居民状况和组织特征。
使用跨国家际研究协会（interRAI）五个参与国家/地区的 14504 家提供护理院级服务的长期护理机构的标准化居民评估工具（RAI）收集基于人群的横断面数据。参与国家包括加拿大、芬兰、中国香港（特别行政区）、瑞士和美国。研究检查了国家间和国家内身体约束和抗精神病药物使用的设施水平流行率。
研究国家之间身体约束使用率的差异超过五倍，从瑞士的平均 6%、美国的 9%、中国香港的 20%、芬兰的 28%到加拿大的 31%以上。抗精神病药物使用率从香港的 11%、加拿大和美国的 26-27%、瑞士的 34%到芬兰的近 38%不等。在每个国家/地区，设施之间在身体约束和抗精神病药物使用率方面都存在很大差异。在所有国家/地区，设施的病例组合和组织特征都不能很好地预测这两种治疗方法的流行率。
在国家间和国家内的护理院设施中，身体约束和抗精神病药物使用的流行率存在很大且无法解释的差异。由于约束和抗精神病药物与不良后果相关，因此了解导致使用率差异的每个国家/地区特有的特殊因素非常重要。
