title: Variability between nursing homes in prevalence of antipsychotic use in patients with dementia.
abstract: BACKGROUND
  Antipsychotic drugs (APD) are widely prescribed for people with dementia residing in long term care facilities (LTCFs). Concern has been expressed that such prescribing is largely inappropriate. The objective of this study is to examine if differences in facility-level prevalence of APD use in a sample of LTCFs for patients with dementia can be explained by patient and facility-related characteristics.
  
  
  METHODS
  A point prevalence study was conducted using data from the VU University Resident Assessment Instrument (VURAI) database from nursing homes and residential care facilities in the Netherlands. Patients were selected who had a diagnosis of dementia. LTCF and patient characteristics were extracted from the VURAI; facility-level resident satisfaction surveys were provided by the National Institute for Public Health.
  
  
  RESULTS
  In total, 20 LTCFs providing care for 1,090 patients with dementia were investigated. Overall, 31% of patients used an APD. In facilities with a high prevalence of APD use behavioral symptoms were present in 62% of their patients. In facilities with medium APD use behavioral problems remained frequent (57%), and in facilities with low prevalence of APD use 54% of the patients had behavioral symptoms. Facilities with a high prevalence of APD use were often large, situated in urban communities, and scored below average on staffing, personal care, and recreational activities.
  
  
  CONCLUSIONS
  There was considerable variation between the participating LTCFs in the prevalence of APD use. Variability was related to LTCF characteristics and patient satisfaction. This indicates potential inappropriate prescribing because of differences in institutional prescribing culture.
authors.affiliation: Careyn Utrecht, Gerimedica, the Netherlands.
authors.forename: Bart C
authors.initials: BC
authors.lastname: Kleijer
authors.affiliation: Geriatric Department, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
authors.forename: Rob J
authors.initials: RJ
authors.lastname: van Marum
authors.affiliation: Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Dinnus H M
authors.initials: DH
authors.lastname: Frijters
authors.affiliation: Department of Geriatrics, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Paul A F
authors.initials: PA
authors.lastname: Jansen
authors.affiliation: Department of Nursing Home Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Miel W
authors.initials: MW
authors.lastname: Ribbe
authors.affiliation: Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Antoine C G
authors.initials: AC
authors.lastname: Egberts
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
authors.forename: Eibert R
authors.initials: ER
authors.lastname: Heerdink
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D001526:Behavioral Symptoms / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D008297:Male; D009426:Netherlands; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012920:Social Behavior Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D014150:Antipsychotic Agents