Castle Nicholas G, Hanlon Joseph T, Handler Steven M
Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
Am J Geriatr Pharmacother. 2009 Jun;7(3):143-50. doi: 10.1016/j.amjopharm.2009.05.001.
The aim of this work was to examine the association between organizational characteristics, market characteristics, and changes in antipsychotic medication use in US nursing homes over time.
This was a longitudinal study comparing antipsychotic use in US nursing homes from 1996 through 2006 using Medicare and Medicaid data (the Online Survey Certification And Reporting system) and US Department of Health and Human Resources Health Resources and Services Administration data (the Area Resource File). The 3 outcomes of interest were increasing, decreasing, or stable use of antipsychotic medications. The primary independent variables were organizational characteristics (eg, for-profit status, chain membership) and market characteristics (eg, Medicaid reimbursement, levels of competition).
Antipsychotic use increased from 16.4% in 1996 to 25.9% in 2006 (P < 0.05). A multinomial generalized estimating equations model, controlling for facility, staffing, and resident factors, suggested that increased antipsychotic use was associated with for-profit facilities (adjusted odds ratio [AOR], 1.58; 95% CI, 1.51-1.65; P < or = 0.001). Decreased antipsychotic use was associated with chain membership (AOR, 0.82; 95% CI, 0.79-0.85; P < or = 0.001), higher levels of competition (AOR, 1.22; 95% CI, 1.16-1.29; P < or = 0.001), and a higher Medicaid reimbursement rate (AOR, 0.88; 95% CI, 0.85-0.92; P < or = 0.001).
Antipsychotic use increased in US nursing homes from 1996 through 2006 and was associated with certain organizational characteristics and market characteristics. Future interventions to reduce antipsychotic use in nursing homes will have to focus on these factors.
本研究旨在探讨美国疗养院的组织特征、市场特征与抗精神病药物使用随时间变化之间的关联。
这是一项纵向研究，利用医疗保险和医疗补助数据（在线调查认证与报告系统）以及美国卫生与公众服务部卫生资源与服务管理局的数据（区域资源文件），比较了1996年至2006年美国疗养院中抗精神病药物的使用情况。感兴趣的3个结果是抗精神病药物使用的增加、减少或稳定。主要自变量为组织特征（如营利性状态、连锁机构成员身份）和市场特征（如医疗补助报销、竞争水平）。
抗精神病药物的使用从1996年的16.4%增至2006年的25.9%（P<0.05）。一个控制了机构、人员配备和居民因素的多项广义估计方程模型表明，抗精神病药物使用的增加与营利性机构相关（调整优势比[AOR]，1.58；95%置信区间[CI]，1.51 - 1.65；P≤0.001）。抗精神病药物使用的减少与连锁机构成员身份（AOR，0.82；95%CI，0.79 - 0.85；P≤0.001）、较高的竞争水平（AOR，1.22；95%CI，1.16 - 1.29；P≤0.001）以及较高的医疗补助报销率（AOR，0.88；95%CI，0.85 - 0.92；P≤0.001）相关。
1996年至2006年期间，美国疗养院中抗精神病药物的使用有所增加，且与某些组织特征和市场特征相关。未来减少疗养院中抗精神病药物使用的干预措施将不得不关注这些因素。
