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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*,†

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.

*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.