An evaluation of the impact of the prospective payment system on antidepressant use in nursing home residents.
OBJECTIVE
To determine the impact of the prospective payment system (PPS) for skilled nursing facilities on the pharmacologic treatment of depression.


METHODS
We used a quasi-experimental study comparing the pharmacological treatment rates for depression in the pre-PPS period (1997) to the post-PPS period (2000) in 8149 residents with documented depression living in over 500 nursing facilities in Ohio. Logistic regression models adjusting for clustering effects of residents residing in homes using generalized estimating equations provided estimates of the PPS effect on use of any antidepressant and the use of selective serotonin reuptake inhibitors (SSRIs). We evaluated the extent to which the PPS effect was modified by organizational characteristics, including structural characteristics, resource characteristics, and staff resources available in the homes.


RESULTS
Overall, there was no difference in the likelihood of any antidepressant [odds ratio (OR), 1.05; 95% confidence interval (CI), 0.93 to 1.18, resident-adjusted model] or an SSRI being used (OR, 0.98; 95% CI, 0.86 to 1.12, resident-adjusted model) after the introduction of PPS compared with 1997 when this reimbursement system was not in place (referent group). These trends did not appear to be modified substantially by organizational characteristics.


CONCLUSIONS
Although PPS did not appear to have influenced the treatment of depression in nursing homes, systems that provide checks and balances in relation to PPS are warranted.
Lapane
Kate L
KL
Center For Gerontology and Health Care Research, Department of Community Health, Brown University, Providence, Rhode Island 02912, USA. Kate_Lapane@Brown.edu
Hughes
Carmel M
CM
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D017723:Drug Utilization Review; D005260:Female; D006302:Health Services Research; D006707:Homes for the Aged / Q000191:economics / Q000592:standards; D006801:Humans; D016015:Logistic Models; D008297:Male; D008483:Medical Assistance / Q000706:statistics & numerical data; D009820:Ohio; D011445:Prospective Payment System / Q000706:statistics & numerical data*; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use; D012866:Skilled Nursing Facilities / Q000191:economics* / Q000592:standards
D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors