Out-of-pocket Costs for Medicines among Community-dwelling Older People in New Zealand

Abstract

Psychotropic medicines associated with significant drug related morbidity and mortality are commonly used in RACFs. There is increasing evidence of a relationship between organisational culture and the quality of health service delivery. According to Schein, organisational culture includes visible behaviour, shared values and underlying assumptions and is influenced by organisational managers. The aim of this study was to investigate the relationship between organisational culture and psychotropic medicine use in RACFs and the role of the manager. Methods: Ethical approval was obtained for this qualitative explorative study, conducted in 8 RACFs within NSW, Australia. Purposive sampling was used to recruit on-site staff [managers (8), registered nurses (11), nursing assistants (5)] and visiting staff [doctors (8), pharmacists (7), nurse practitioners (1), clinical nurse consultants (1), specialist medical practitioners (1)] for participation in a semi-structured interview. The interview guide was based on Schein’s theory. Interviews were conducted between September 2012 and July 2013, digitally recorded and transcribed verbatim. The method of constant comparison was used to derive themes. Results: Analysis revealed features of organisational culture related to the use of psychotropic medicines in RACFs, with four major themes emerging: espoused values for resident care; inter-professional collaboration; adoption of quality improvement interventions; and staff work-load. Prioritisation of non-pharmacological management was established by RACF managers and shared by staff. Several mangers promoted inter-professional collaboration which facilitated quality use of psychotropics. Managers’ implementation of interventions to review psychotropic prescribing varied amongst RACFs. Majority of staff recognised the impact of work load on the preference for psychotropics use. Conclusions: RACF managers shape the culture of the organisation by the promotion of values and practices directed at quality use of psychotropic medicines. Strategies designed to address psychotropic prescribing in RACFs should consider organisational culture and enlist the support of managers to ensure successful implementation.