Garrard J, Chen V, Dowd B
Institute for Health Services Research, School of Public Health, University of Minnesota, Minneapolis 55455-0381, USA.
Am J Public Health. 1995 Jun;85(6):771-6. doi: 10.2105/ajph.85.6.771.
The purpose of this study was to examine prevalence rates of psychotropic drug use by elderly nursing home residents 3 years before and 1 year after implementation of the 1987 Omnibus Budget Reconciliation Act drug regulations throughout the United States on October 1, 1990.
A cohort study was conducted of elderly nursing home residents, for each of 4 study years (approximately 33,000 residents per year), of all nursing homes (n = 372) in Minnesota certified by Medicare and Medicaid. Data included (1) health status assessment and psychotropic drug use; (2) nursing home and care characteristics; and (3) county geographic and population characteristics.
Annual rates of antipsychotic drug use declined by one third over the 4-year period (23%, 22%, 19%, and 15% from 3 years before enforcement of the regulations to 1 year afterward). All differences were statistically significant. Antianxiety use rates were 11%, 12%, 12%, and 12%, respectively, and antidepressant use rates were 14%, 15%, 16%, 16%, respectively, for the 4 years. The latter two classes of drugs were not affected directly by the regulations.
Declines in the rates of antipsychotic drug use appear to be associated with anticipation of the regulations the year before and as the result of the regulations the year after the October 1990 implementation. A hypothesized medication shift to benzodiazepine drugs was not observed.
本研究旨在调查1990年10月1日美国全面实施1987年《综合预算协调法案》药物监管规定之前3年及之后1年，老年疗养院居民使用精神药物的患病率。
对明尼苏达州所有经医疗保险和医疗补助认证的疗养院（n = 372）中的老年疗养院居民进行了一项队列研究，共4个研究年份（每年约33,000名居民）。数据包括：（1）健康状况评估和精神药物使用情况；（2）疗养院和护理特征；（3）县地理和人口特征。
在4年期间，抗精神病药物的年使用率下降了三分之一（从监管实施前3年到实施后1年，分别为23%、22%、19%和15%）。所有差异均具有统计学意义。4年中，抗焦虑药物使用率分别为11%、12%、12%和12%，抗抑郁药物使用率分别为14%、15%、16%和16%。后两类药物未直接受到监管规定的影响。
抗精神病药物使用率的下降似乎与1990年10月实施前一年对监管规定的预期以及实施后一年监管规定的结果有关。未观察到假设的药物转向苯二氮䓬类药物的情况。
