Llorente M D, Olsen E J, Leyva O, Silverman M A, Lewis J E, Rivero J
University of Miami School of Medicine, Florida, USA.
J Am Geriatr Soc. 1998 Feb;46(2):198-201. doi: 10.1111/j.1532-5415.1998.tb02539.x.
To examine the degree and patterns of compliance with the Omnibus Budget Reconciliation Act (OBRA) regulations regarding the use of antipsychotic drugs in nursing homes.
Retrospective chart review of all resident records.
Eight nursing homes: five community, two county-owned, and one university-affiliated Veterans Administration facility.
A structured assessment instrument to track compliance with each aspect of the OBRA regulations regarding antipsychotic drug use.
A total of 1573 nursing home residents' pharmacy records were reviewed between August 1994 and March 1996. Two hundred seventy-nine residents were actively taking antipsychotic medications (prevalence = 17.7%). Mean compliance greater than 70% was found for (1) appropriate diagnostic indication (mean = 70.9%), (2) dosage within recommended limits (mean = 90.1%), and 3) documented appropriate target symptoms (mean = 90.4%). Dosages were more likely to exceed limits in those patients with histories of major mental illness, particularly schizophrenia.
Nursing homes were better able to comply with those guidelines that are most specific. Educational interventions now need to focus on behavioral interventions, monitoring of adverse effects, and efficacy. These data are useful in establishing threshold levels of performance and can be used by nursing homes for continuous quality improvement. OBRA continues to impact neuroleptic drug prescribing practices in nursing homes significantly.
研究疗养院在使用抗精神病药物方面遵守《综合预算协调法案》（OBRA）规定的程度和模式。
对所有居民记录进行回顾性图表审查。
八家疗养院：五家社区疗养院、两家县属疗养院和一家大学附属退伍军人管理局设施。
一种结构化评估工具，用于跟踪疗养院在抗精神病药物使用方面遵守OBRA规定各方面的情况。
在1994年8月至1996年3月期间，共审查了1573名疗养院居民的药房记录。279名居民正在积极服用抗精神病药物（患病率 = 17.7%）。发现以下方面的平均合规率大于70%：（1）有适当的诊断指征（平均 = 70.9%），（2）剂量在推荐限度内（平均 = 90.1%），以及（3）记录有适当的目标症状（平均 = 90.4%）。有重度精神疾病史的患者，尤其是精神分裂症患者，其剂量更有可能超过限度。
疗养院更能遵守那些最具体的指导方针。现在，教育干预需要侧重于行为干预、不良反应监测和疗效。这些数据有助于确定绩效阈值水平，并可被疗养院用于持续质量改进。OBRA继续对疗养院中抗精神病药物的处方实践产生重大影响。
