Abstract
We reviewed 384,326 prescriptions for 5,902 Medicaid patients residing continuously for one year in 173 Tennessee nursing homes. Of these patients, 43 per cent received antipsychotic drugs; 9 per cent were chronic recipients (received at least 365 daily doses per year). Of the 1,580 physicians who cared for these patients, 42 per cent prescribed antipsychotic medication. Physicians with large nursing home practices (10 or more patients) prescribed 81 per cent of the total antipsychotic medication, and were usually family practitioners (78 per cent) and in rural practice (47 per cent). As nursing home practice size increased, doctors prescribed more drug per patient (p less than .001). Wide variation in antipsychotic drug use occurred among nursing homes; the chronic recipient rate ranged from 0 to 46 per cent. More drug was given per patient in larger homes (r = .18, p less than .05). Typically, one physician (the "dominant" physician) provided care for the majority of a nursing home's patients. The proportion of a home's patients seen by the dominant physician was correlated with the chronic recipient rate (r = .17, p less than .05). These findings provide epidemiologic evidence suggesting misuse of antipsychotic drugs in nursing homes. They illustrate the need for investigations of techniques for patient management in nursing homes which rely less upon psychtropic drugs.
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- Buchanan D. S. Iatrogenic causes of neurologic disorders: part 2. Drug-related dysfunctions. Geriatrics. 1978 Sep;33(9):47–52. [PubMed] [Google Scholar]
- Covert A. B., Rodrigues T., Solomon K. The use of mechanical and chemical restraints in nursing homes. J Am Geriatr Soc. 1977 Feb;25(2):85–89. doi: 10.1111/j.1532-5415.1977.tb00236.x. [DOI] [PubMed] [Google Scholar]
- Eisdorfer C. Observations on the psychopharmacology of the aged. J Am Geriatr Soc. 1975 Feb;23(2):53–57. doi: 10.1111/j.1532-5415.1975.tb00383.x. [DOI] [PubMed] [Google Scholar]
- Federspiel C. F., Ray W. A., Schaffner W. Medicaid records as a valid data source: the Tennessee experience. Med Care. 1976 Feb;14(2):166–172. doi: 10.1097/00005650-197602000-00006. [DOI] [PubMed] [Google Scholar]
- Ingman S. R., Lawson I. R., Pierpaoli P. G., Blake P. A survey of the prescribing and administration of drugs in a long-term care institution for the elderly. J Am Geriatr Soc. 1975 Jul;23(7):309–316. doi: 10.1111/j.1532-5415.1975.tb00219.x. [DOI] [PubMed] [Google Scholar]
- Kane R. L., Jorgensen L. A., Teteberg B., Kuwahara J. Is good nursing-home care feasible? JAMA. 1976 Feb 2;235(5):516–519. [PubMed] [Google Scholar]
- Kobayashi R. M. Drug therapy of tardive dyskinesia. N Engl J Med. 1977 Feb 3;296(5):257–260. doi: 10.1056/NEJM197702032960506. [DOI] [PubMed] [Google Scholar]
- Learoyd B. M. Psychotropic drugs and the elderly patient. Med J Aust. 1972 May 27;1(22):1131–1133. [PubMed] [Google Scholar]
- Linn M. W., Gurel L., Linn B. S. Patient outcome as a measure of quality of nursing home care. Am J Public Health. 1977 Apr;67(4):337–344. doi: 10.2105/ajph.67.4.337. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Maurer A. S. Management of emotional disturbances in geriatric patients. J Am Geriatr Soc. 1973 May;21(5):226–228. doi: 10.1111/j.1532-5415.1973.tb01675.x. [DOI] [PubMed] [Google Scholar]
- Pineau R., Lachance R., Pelchat G., Jus K., Pires P., Pires P., Villenueve Epidemiology of tardive dyskinesia Part I. Dis Nerv Syst. 1976 Apr;37(4):210–214. [PubMed] [Google Scholar]
- Prien R. F., Haber P. A., Caffey E. M., Jr The use of psychoactive drugs in elderly patients with psychiatric disorders: survey conducted in twelve Veterans Administration hospitals. J Am Geriatr Soc. 1975 Mar;23(3):104–112. doi: 10.1111/j.1532-5415.1975.tb00969.x. [DOI] [PubMed] [Google Scholar]
- Ray W. A., Brocklebank J. C., Federspiel C. F. Computerized system for the identification of ingredients of proprietary compounds. Am J Hosp Pharm. 1977 Aug;34(8):847–849. [PubMed] [Google Scholar]