title: Which organizational characteristics are associated with increased management of depression using antidepressants in US nursing homes?
abstract: BACKGROUND
  There is universal agreement that organizational characteristics of nursing facilities can and do influence the quality of care and resident outcomes.
  
  
  OBJECTIVE
  This study evaluated the relation between organizational characteristics and management of depression using antidepressants.
  
  
  METHODS
  This was a cross-sectional study of Medicare/Medicaid certified nursing homes in 6 states in 2000.
  
  
  METHODS
  We studied 87,907 residents with depression in 2,128 facilities.
  
  
  METHODS
  Minimum Data Set (MDS) provided information regarding use of antidepressants and resident factors. On-line Survey and Certification of Automated Records (OSCAR) provided facility characteristics information including structural, resource, and staffing levels. Adjusted estimates of organizational effects on antidepressant drug use were derived from generalized estimating equations.
  
  
  RESULTS
  Increased treatment of depression with antidepressants was associated with facilities with a higher percentage of residents from payer sources other than Medicare/Medicaid (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06) and more professional nursing staff (OR, 1.15; 95% CI, 1.05-1.26). Decreased treatment tended to be related to larger homes (OR, 0.76; 95% CI, 0.68-0.84) or if the home employed full-time physicians (OR, 0.87; 95% CI, 0.78-0.96). Once the decision to treat was made, treatment with tricyclics tended to be inversely related to larger homes, for-profit facilities, and homes with more Medicare residents.
  
  
  CONCLUSIONS
  Facilities that are required to be more fiscally conservative, be it larger facilities with fewer private pay patients or for profit facilities, have lower rates of pharmacologic treatment. Resource and structural characteristics influence the type of antidepressant being prescribed; resident characteristics may not be the over-riding factor in prescribing.
authors.affiliation: Center For Gerontology and Health Care Research, Department of Community Health, Brown University, Providence, Rhode Island 02912, USA. Kate_Lapane@Brown.edu
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lapane
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hughes
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy*; D004363:Drug Utilization; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D017533:Marital Status; D008484:Medicaid; D006278:Medicare; D009735:Nursing Homes / Q000191:economics / Q000458:organization & administration; D016017:Odds Ratio; D011787:Quality of Health Care; D014481:United States; D000078329:Workforce
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic