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Variation in Nursing Home Antipsychotic Prescribing Rates
Paula A. Rochon, MD, MPH;
Therese A. Stukel, PhD;
Susan E. Bronskill, PhD;
Tara Gomes, MHSc;
Kathy Sykora, MSc;
Walter P. Wodchis, PhD;
Michael Hillmer, MSc;
Alexander Kopp, BA;
Jerry H. Gurwitz, MD;
Geoffrey M. Anderson, MD, PhD
Arch Intern Med. 2007;167(7):676-683.
Background Excessive prescribing of antipsychotic therapy is a concern owing to their potential to cause serious adverse events. We explored variation in the use of antipsychotic therapy across nursing homes in Ontario, Canada, and determined if prescribing decisions were based on clinical indications.
Methods A point-prevalence study of antipsychotic therapy use in 47 322 residents of 485 provincially regulated nursing homes in December 2003. Facilities were classified into quintiles according to their mean antipsychotic prescribing rates. Residents were grouped into those with a potential clinical indication or no identified clinical indication for antipsychotic therapy.
Results A total of 15 317 residents (32.4%) were dispensed an antipsychotic agent. The mean rate of antipsychotic prescribing by home ranged from 20.9% in the quintile of facilities with the lowest mean prescribing rates (quintile 1) to 44.3% in facilities with the highest mean prescribing rates (quintile 5). Compared with individuals residing in nursing homes with the lowest mean antipsychotic prescribing rates, those residing in facilities with the highest rates were 3 times more likely to be dispensed an antipsychotic agent (adjusted odds ratio [AOR], 3.0; 95% confidence interval [CI], 2.74-3.19). Similar rates were observed among residents with psychoses with or without dementia (AOR, 2.7; 95% CI, 2.35-3.09) and residents without psychoses or dementia (AOR, 2.9; 95% CI, 2.19-3.81) who had no identifiable indication for an antipsychotic therapy.
Conclusion Residents in facilities with high antipsychotic prescribing rates were about 3 times more likely than those in facilities with low prescribing rates to be dispensed an antipsychotic agent, irrespective of their clinical indication.
Author Affiliations: Kunin-Lunenfeld Applied Research Unit, Baycrest, Toronto, Ontario (Dr Rochon); Departments of Medicine (Dr Rochon) and Health Policy, Management, and Evaluation (Drs Rochon, Stukel, Bronskill, Wodchis, and Anderson), University of Toronto; Institute for Clinical Evaluative Sciences, Toronto (Drs Rochon, Stukel, Bronskill, Wodchis, and Anderson; Mss Gomes and Sykora; and Messrs Hillmer and Kopp); Toronto Rehabilitation Institute (Dr Wodchis); and Meyers Primary Care Institute, University of Massachusetts Medical School, the Fallon Clinic Foundation, and Fallon Community Health Plan, Worcester (Dr Gurwitz).
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