title: Challenge of changing nursing home prescribing culture.
abstract: This article described a framework for improving prescribing in nursing homes (NH) by focusing on the whole facility as a system that has created a "prescribing culture." We offered this paradigm as an alternative to focused interventions that target prescribers only. We used the example of atypical antipsychotics to illustrate the approach. We also highlighted elements of the NH culture change movement that are germane to medication prescribing, and illustrated which elements of NH culture were shown to be associated with suboptimal quality of care. We concluded by describing current models, including our study funded by the Agency for Healthcare Research and Quality, to identify the best methods of disseminating evidence-based medication use guides in NHs.
authors.affiliation: Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA. jennifer.tjia@umassmed.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tjia
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: Becky A
authors.initials: BA
authors.lastname: Briesacher
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006707:Homes for the Aged; D006801:Humans; D009735:Nursing Homes / Q000458:organization & administration* / Q000592:standards; D015279:Organizational Culture; D010818:Practice Patterns, Physicians' / Q000592:standards*; D014481:United States
chemical_list: D014150:Antipsychotic Agents