Shorr R I, Fought R L, Ray W A
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-2637.
JAMA. 1994 Feb 2;271(5):358-62.
To describe the changes in antipsychotic drug use in nursing homes during the period surrounding the implementation of federal legislation designed to reduce unnecessary use (the Omnibus Budget Reconciliation Act of 1987 [OBRA-87]) and to identify nursing home characteristics associated with such changes.
Longitudinal study of 9432 Tennessee Medicaid enrollees 65 years of age or older who continuously resided in Tennessee from April 1, 1989, to September 30, 1991, a 30-month period surrounding implementation of OBRA-87.
Changes in the use of antipsychotic and other psychotropic drugs.
During the 30-month period, antipsychotic drug use decreased from 23.9 to 17.5 days per 100 days of residence, a 26.7% decline (P < .001), which resulted from both a decrease in new users (P < .001) and a reduction in long-term use of antipsychotic drugs (P < .001). There was no concomitant increase in other psychotropic drug use. A multivariate analysis revealed that changes in antipsychotic use were strongly associated with baseline antipsychotic use (P = .001) and third-shift staffing levels (P = .003). Nursing homes with baseline antipsychotic drug use and third-shift staffing above the median reduced antipsychotic drug use by 41%, compared with a 2% increase in nursing homes where both of these factors were below the median (P < .0001).
A substantial decrease in antipsychotic drug use coincided with the implementation of OBRA-87. Although this decrease is consistent with an improvement in quality of nursing home care, further research is needed to determine the effects of this legislation on resident outcomes.
描述在旨在减少不必要使用抗精神病药物的联邦立法（1987年《综合预算协调法案》[OBRA - 87]）实施前后期间养老院中抗精神病药物使用的变化，并确定与这些变化相关的养老院特征。
对9432名65岁及以上的田纳西州医疗补助参保者进行纵向研究，这些参保者在1989年4月1日至1991年9月30日期间持续居住在田纳西州，这是围绕OBRA - 87实施的30个月期间。
抗精神病药物和其他精神药物使用的变化。
在这30个月期间，抗精神病药物的使用从每100天居住日23.9天降至17.5天，下降了26.7%（P <.001），这是新使用者减少（P <.001）和抗精神病药物长期使用减少（P <.001）共同导致的。其他精神药物的使用没有相应增加。多变量分析显示，抗精神病药物使用的变化与基线抗精神病药物使用情况（P =.001）和三班倒人员配备水平（P =.003）密切相关。基线抗精神病药物使用和三班倒人员配备高于中位数的养老院，抗精神病药物使用减少了41%，而这两个因素均低于中位数的养老院则增加了2%（P <.0001）。
抗精神病药物使用的大幅减少与OBRA - 87的实施同时发生。虽然这种减少与养老院护理质量的改善相一致，但需要进一步研究以确定该立法对居民结局的影响。
