JAMDA
Volume 7, Issue 5 , Pages 294-304 , June 2006

Use of Medication Technicians in US Nursing Homes: Part of the Problem or Part of the Solution?

  • Carmel M. Hughes, PhD

      Affiliations

    • School of Pharmacy, Queen’s University of Belfast, Belfast, Northern Ireland
    • Corresponding Author InformationAddress correspondence to Carmel M. Hughes, School of Pharmacy, Queen’s University Belfast, 97 Lisburn Road, Belfast, Northern Ireland, BT9 7BL.
    • ,
  • Rollin M. Wright, MD

      Affiliations

    • Center For Gerontology and Health Care Research, Department of Internal Medicine, Brown Medical School, Providence, RI
    • ,
  • Kate L. Lapane, PhD

      Affiliations

    • Department of Community Health, Brown University, Providence, RI

References 

  1. Elon R , Pawlson LG . The impact of OBRA on medical practices within nursing facilities . J Am Geriatr Soc . 1992;40:958–963
  2. Facility Guide for the Nursing Home Quality Indicators. National Data Systems. Center for Health Systems Research and Analysis, University of Wisconsin, Madison. Available at www.cms.hhs.gov/medicaid/ltcsp/manual.pdf. Accessed October 18th, 2004.
  3. Schnelle JF , Bates-Jensen BM , Chu L , et al.   Accuracy of nursing home medical record information about care-process delivery (Implications for staff management and improvement) . J Am Geriatr Soc . 2004;52:1378–1388
  4. Schnelle JF , Alessi CA , Simmons SF , et al.   Translating clinical research into practice (A randomized controlled trial of exercise and incontinence care with nursing home residents) . J Am Geriatr Soc . 2002;50:1476–1483
  5. Report to Congress: Appropriateness of minimum nurse staffing ratios in nursing homes. Phase I report, Vols I–III . Cambridge, MA: Abt Associates Inc; 2000;
  6. Chiha YA , Link CR . The shortage of registered nurses and some new estimates of the effects of wages on registered nurses labor supply (A look at the past and a preview of the 21st century) . Health Policy . 2003;64:349–375
  7. Ray WA , Federspiel CF , Schaffner W . Study of antipsychotic drug use in nursing homes (epidemiologic evidence suggesting misuse) . Am J Pub Health . 1980;70:485–491
  8. Svarstad BL , Mount JK . Nursing home resource and tranquilizer use among the institutionalized elderly . J Am Geriatr Soc . 1991;39:869–875
  9. Hughes CM , Lapane KL , Mor V . Influence of facility characteristics on use of antipsychotic medication use in nursing homes . Med Care . 2000;38:1164–1173
  10. Lapane KL , Hughes CM . Which organizational characteristics are associated with increased management of depression using antidepressants in US nursing homes? . Med Care . 2004;42:992–1000
  11. Glazer G , Doheny M , Geolot D . Nurse reinvestment act: Implications for the nursing profession: Discussion with Denise Geolot . Online J Issues Nurs . 2004;9:8
  12. Zimmerman SI , Girman CJ , Buie VC , et al.   The prevalence of osteoporosis in nursing home residents . Osteoporos Int . 1999;9:151–157
  13. Chandler JM , Zimmerman SI , Girman CJ , et al.   Low bone mineral density and risk of fracture in white female nursing home residents . JAMA . 2000;284:972–977
  14. Rojas-Fernandez CH , Lapane KL , MacKnight C , et al.   Under-treatment of osteoporosis in residents of nursing homes (Population-based study with use of the Systematic Assessment of Geriatric Drug Use via Epidemiology (SAGE) database) . Endocrine Pract . 2002;8:335–342
  15. Ekman A , Michaelsson K , Ljunghall S , et al.   Almost all institutionalized women are osteoporotic, when measured by heel and finger ultrasound . J Intern Med . 2001;249:173–180
  16. American Association of Clinical Endocrinologists Osteoporosis Guidelines . Endocrine Pract . 2003;9:544–564
  17. Centers for Medicare and Medicaid Services. Available at: www.CMS.gov. Accessed October 18, 2004.
  18. Strahan G . An overview of nursing homes and their current residents: Data from the 1995 National Nursing Homes Survey. Advance data from the Vital and Health Statistics, no. 280 . Hyattsville, MD: National Center for Health Statistics; 1997;
  19. Intrator O , Castle NG , Mor V . Facility characteristics associated with hospitalization of nursing home residents . Med Care . 1999;37:229–237
  20. Lapane KL , Hughes CM . An evaluation of the impact of the prospective payment system on antidepressant use in nursing homes residents . Med Care . 2004;42:48–58
  21. Lapane KL , Hughes CM . Which organizational characteristics are associated with increased management of depression using antidepressants in US nursing homes? . Med Care . 2004;42:992–1000
  22. Kansas Administrative Regulations. Kansas Department of Health and Environment. Rules and regulations for certification of medication aides. Available at: www.kdhe.state.ks.us/hoc//regs/cma_regs.pdf. Accessed October 16, 2004.
  23. Department of Professional and Financial Regulation, Maine. Regulations relating to training programs and delegation by registered professional nurses of selected nursing tasks to certified nursing assistants. Available at: www.state.me.us/boardofnursing/rules_files/rules.html. Accessed on October 12, 2004.
  24. Board of Quality Assurance, Wisconsin. Memo to Nursing homes. Criteria for Medication Aides in Nursing Homes. Available at: www.dhfs.wisconsin.gov/rl_dsl/nhs/nh00-055.htm. Accessed October 12, 2004.
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  28. Wright RM, Lapane KL. Fractured use of osteoporosis medications in nursing facilities: Missed opportunity for prevention or rational prescribing. In preparation.
  29. Centers for Medicare and Medicaid Services . Appropriateness of Minimum Nurse Staffing Ratios in Nursing Homes (Phase II Final Report) . Cambridge, MA: Abt Associates; 2001;
  30. Schnelle JF , Simmons SF , Harrington C , et al.   Relationship of nursing home staffing to quality of care . Health Serv Res . 2004;39:225–250
  31. Sloane PD , Gruber-Baldini AL , Zimmerman S , et al.   Medication undertreatment in assisted living settings . Arch Intern Med . 2004;164:2031–2037
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  33. Gurwitz JH . Polypharmacy (A new paradigm for quality drug therapy in the elderly?) . Arch Intern Med . 2004;164:1957–1959
  34. Hughes CM , Lapane KL . The drive for quality care in US nursing homes in the era of the Prospective Payment System . Drugs Aging . 2002;19:623–631
  35. Brown MN , Lapane KL , Luisi A . Management of depression in elderly nursing home residents . J Am Geriatr Soc . 2002;50:69–76
  36. Quilliam BJ , Lapane KL . Clinical correlates and drug treatment of residents with stroke in long-term care . Stroke . 2001;32:1385–1393
  37. Spooner JJ , Lapane KL , Hume AL , et al.   Pharmacologic treatment of diabetes in long term care . J Clin Epidemiol . 2001;54:525–530
  38. Stevenson DG , Studdert DM . The rise of nursing home litigation (Findings from a national survey of attorneys) . Health Aff (Millwood) . 2003;22:219–229
  39. Ouslander JG , Fitzler S , Minnix WL , et al.   Accuracy (or lack thereof) of nursing home individual records (What do industry and professional organizations have to say?) . J Am Geriatr Soc . 2004;52:1395–1398

 Dr Hughes is currently being supported by a National Primary Care Career Scientist award from the Research and Development Office, Northern Ireland. Dr Wright is supported by a postdoctoral T32 training grant from the Agency for Healthcare Research and Quality.All authors were involved in the study concept and design, data analysis and interpretation, and preparation of the manuscript.All authors have no other conflicts of interest.Approved by the ACEP Board of Directors September 2005.

PII: S1525-8610(05)00650-X

doi: 10.1016/j.jamda.2005.11.011

JAMDA
Volume 7, Issue 5 , Pages 294-304 , June 2006

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