Results of a longitudinal analysis of national data to examine relationships between organizational and market characteristics and changes in antipsychotic prescribing in US nursing homes from 1996 through 2006

Abstract

Objective: The aim of this work was to examine the association between organizational characteristics, market characteristics, and changes in antipsychotic medication use in US nursing homes over time. Methods: This was a longitudinal study comparing antipsychotic use in US nursing homes from 1996 through 2006 using Medicare and Medicaid data (the Online Survey Certification And Reporting system) and US Department of Health and Human Resources Health Resources and Services Administration data (the Area Resource File). The 3 outcomes of interest were increasing, decreasing, or stable use of antipsychotic medications. The primary independent variables were organizational characteristics (eg, for-profit status, chain membership) and market characteristics (eg, Medicaid reimbursement, levels of competition). Results: Antipsychotic use increased from 16.4% in 1996 to 25.9% in 2006 ( P < 0.05). A multinomial generalized estimating equations model, controlling for facility, staffing, and resident factors, suggested that increased antipsychotic use was associated with for-profit facilities (adjusted odds ratio [AOR], 1.58; 95% CI, 1.51–1.65; P ≤ 0.001). Decreased antipsychotic use was associated with chain membership (AOR, 0.82; 95% CI, 0.79–0.85; P ≤ 0.001), higher levels of competition (AOR, 1.22; 95% CI, 1.16–1.29; P ≤ 0.001), and a higher Medicaid reimbursement rate (AOR, 0.88; 95% CI, 0.85–0.92; P ≤ 0.001). Conclusions: Antipsychotic use increased in US nursing homes from 1996 through 2006 and was associated with certain organizational characteristics and market characteristics. Future interventions to reduce antipsychotic use in nursing homes will have to focus on these factors.