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Original Study| Volume 11, ISSUE 5, P320-324, June 2010

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Antidepressant Prescribing in US Nursing Homes Between 1996 and 2006 and Its Relationship to Staffing Patterns and Use of Other Psychotropic Medications

  • Joseph T. Hanlon
    Correspondence
    Address correspondence to Joseph T. Hanlon, PharmD, MS, Department of Medicine (Geriatrics), University of Pittsburgh, Kaufman Medical Building, Suite 514, 3471 5th Avenue, Pittsburgh, PA 15213.
    Affiliations
    Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA

    Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA

    Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA

    Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System (VAPHS), Pittsburgh, PA

    Center for Health Equity Research and Promotion (CHERP), VAPHS, Pittsburgh, PA
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  • Steven M. Handler
    Affiliations
    Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA

    Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Pittsburgh Healthcare System (VAPHS), Pittsburgh, PA

    Center for Health Equity Research and Promotion (CHERP), VAPHS, Pittsburgh, PA

    Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA
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  • Nicholas G. Castle
    Affiliations
    Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
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      Background

      Few studies have examined factors associated with antidepressant prescribing in older nursing home residents.

      Objective

      The primary objective was to describe the change in antidepressant prescribing for nursing home residents between 1996 and 2006. An additional objective was to examine the association between any change in antidepressant prescribing and staffing patterns or coprescribing of other psychotropic medications in the same cohort.

      Design

      Longitudinal.

      Settings

      Settings were 12,556 US nursing homes in 1996 and 2006.

      Data Sources

      Online Survey Certification and Reporting (OSCAR) data and the Area Resource File (ARF).

      Measurements

      Increasing prescribing of antidepressants analyzed using multivariable multinomial generalized estimating equations (GEE).

      Results

      Antidepressant prescribing significantly increased (P < .05) from 21.9% in 1996 to 47.5% in 2006. After controlling for resident, organizational, and market factors, increased antidepressant prescribing was associated with more time spent by physician extenders (adjusted odds ratio [AOR] 2.21; 95% confidence interval [CI] 1.96–2.51), registered nurses (AOR 1.06, 95% CI 1.02–1.10), or nurse aides (AOR 1.08; 95%CI 1.04–1.12) in a facility, as well as the coprescribing of sedative/hypnotics (AOR 1.12; 95% CI 1.08–1.16). Factors found to be protective of increasing antidepressant prescribing (ie, decrease antidepressant prescribing) included having medical directors and physicians spend more time in the facility (AOR 0.60; 95% CI 0.53–0.69 and AOR 0.62; 95% CI 0.54–0.71, respectively), or coprescribing of antianxiety or antipsychotic agents (AOR 0.70; 95% CI 0.68–0.72 and AOR 0.74; 95% CI 0.72–0.77, respectively).

      Conclusions

      Prescribing of antidepressants has increased dramatically in the past decade in older nursing home residents and seems to be associated with certain staffing characteristics and the coprescribing of psychotropic medications. Further research is needed to determine if antidepressants are appropriately prescribed, and if overuse is determined, develop interventions to improve the quality of prescribing of these medications in older nursing home residents.

      Keywords

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