You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Antipsychotic Use in Nursing Homes Varies by Psychiatric Consultant

Tjia, Jennifer MD, MSCE*,†; Field, Terry DSc*,†; Lemay, Celeste RN, MPH*,†; Mazor, Kathleen EdD*,†; Pandolfi, Michelle MSW, MBA, LNHA; Spenard, Ann RN; Ho, Shih-Yieh PhD, MPH; Kanaan, Abir PharmD*,§; Donovan, Jennifer PharmD*,§; Gurwitz, Jerry H. MD*,†; Briesacher, Becky PhD*,†

Medical Care:
doi: 10.1097/MLR.0000000000000076
Brief Report

Background: The relationship between psychiatric consultation and antipsychotic prescribing in nursing homes (NH) is unknown.

Objective: To identify the association between psychiatric consultant groups and NH-level antipsychotic prescribing after adjustment for resident case-mix and facility characteristics.

Research Design and Subjects: Nested cross-sectional study of 60 NHs in a cluster randomized trial. We linked facility leadership surveys to October 2009–September 2010 Minimum Data Set, Nursing Home Compare, the US Census, and pharmacy dispensing data.

Measures: The main exposure is the psychiatric consultant group and the main outcome is NH-level prevalence of atypical antipsychotic use. We calculated annual means and interquartile ranges of NH-level antipsychotic use for each consultant group and arrayed consultant groups from lowest to highest prevalence. Generalized linear models were used to predict antipsychotic prescribing adjusting for resident case-mix and facility characteristics. Observed versus predicted antipsychotic prescribing levels were compared for each consultant group.

Results: Seven psychiatric consultant groups served a range of 3–27 study facilities. Overall mean facility-level antipsychotic prescribing was 19.2%. Mean prevalence of antipsychotic prescribing ranged from 12.2% (SD, 5.8) in the lowest consultant group to 26.4% (SD, 3.6) in the highest group. All facilities served by the highest-ranked consultant group had observed antipsychotic levels exceeding the overall study mean with half exceeding predictions for on-label indications, whereas most facilities served by the lowest-ranked consultant group had observed levels below the overall study and predicted means.

Conclusions: Preliminary evidence suggests that psychiatric consultant groups affect NH antipsychotic prescribing independent of resident case-mix and facility characteristics.

Author Information

*University of Massachusetts Medical School

Meyers Primary Care Institute, Worcester, MA

Qualidigm, Wethersfield, CT

§Massachsuetts College of Pharmacy and Health Sciences, Worcester, MA

Supported by a grant from the Agency for Healthcare Quality and Research (R18 HS 019351). B.B. supported by NIH-NIA K01AG031836.

This research was accepted for presentation as a research abstract to the 29th International Conference on Pharmacoepidemiology & Therapeutic Risk Management, Montreal, Canada, August 25–28, 2013.

The authors declare no conflict of interest.

Reprints: Jennifer Tjia, MD, MSCE, Division of Geriatric Medicine, University of Massachusetts Medical School, Biotech 4, Suite 315, 377 Plantation Street, Worcester, MA 01605. E-mail:

© 2014 by Lippincott Williams & Wilkins.