Stoudemire A, Smith D A
Emory Clinic, Section of Psychiatry, Atlanta, GA 30322, USA.
Gen Hosp Psychiatry. 1996 Mar;18(2):77-94. doi: 10.1016/0163-8343(95)00130-1.
This article reviews governmental guidelines regulating the use of psychotropic drugs in long-term care facilities as established by the Omnibus Budget Reconciliation Act (OBRA) of 1987 and their impact on the use of psychotropic agents in these settings. A major component of these guidelines is to regulate the clinical indications for psychoactive drugs (neuroleptics, benzodiazepines, and sedative hypnotics) in residents of long-term care facilities. Responsibilities of the prescribing physician, facility medical director, and consulting pharmacist--as well as quality assurance procedures-in complying with OBRA regulations are examined. Evidence that OBRA regulations have reduced the use of psychotropic drugs and physical restraints in long-term nursing facilities is reviewed. Implications of the OBRA regulations for the training and clinical practice of psychiatrists and primary care clinicians are discussed as well as recommendations for increasing the availability of mental health services for this patient population via multidisciplinary geropsychiatric consultation-liaison teams.
本文回顾了1987年《综合预算协调法案》（OBRA）所制定的关于长期护理机构中精神药物使用的政府指南，以及这些指南对这些机构中精神药物使用的影响。这些指南的一个主要组成部分是规范长期护理机构居民使用精神活性药物（抗精神病药、苯二氮䓬类药物和镇静催眠药）的临床指征。文中探讨了开处方医生、机构医疗主任和咨询药剂师的职责，以及在遵守OBRA法规方面的质量保证程序。还回顾了OBRA法规减少长期护理机构中精神药物和身体约束使用的证据。讨论了OBRA法规对精神科医生和初级保健临床医生培训及临床实践的影响，以及通过多学科老年精神科会诊-联络团队增加该患者群体心理健康服务可及性的建议。
