title: Quality of psychopharmacological medication use in nursing home residents.
abstract: BACKGROUND
  Despite well-documented evidence regarding antipsychotic use in older adults residing in nursing homes (NHs), there is a lack of evidence-based use and quality benchmarks for other psychopharmacological medications (PPMs), including antidepressants, anxiolytics, and sedative-hypnotics.
  
  
  OBJECTIVE
  To estimate the prevalence and patterns of use of PPMs and to measure the quality of PPM use.
  
  
  METHODS
  Using a 5% random sample of 2007 Medicare claims data linked to the Minimum Data Set 2.0, this cross-sectional study identified a nationally representative sample of 69,832 NH residents with ≥3 months of institutionalization. This study measured 1-year prevalence and quality of PPM use, as assessed by indication, dose, and duration of use defined and operationalized according to the current Centers for Medicare and Medicaid Services Unnecessary Medication Guidance for Surveyors and relevant practice guidelines.
  
  
  RESULTS
  Over two-thirds of residents (72.1%, n=50,349) used ≥1 PPM in 2007, with the highest prevalence seen in antidepressants (59.4%), and the lowest in anxiolytics (8.9%). Almost two-thirds (61.0%) of PPM users used ≥2 PPM classes. Compared to other PPM therapeutic classes, antipsychotic users had greatest evidence of guideline adequate use by indication (95.8%) and dose (78.7%). In addition, longer duration of adequate treatment was observed among antipsychotic users (mean = 208 days, standard deviation [SD] = 118) as compared to anxiolytic (mean = 159 days, SD = 118) and sedative-hypnotic users (mean = 183 days, SD = 117).
  
  
  CONCLUSIONS
  This study found that PPM use remains highly prevalent among long-stay Medicare NH residents. While antipsychotic use remained high (31.5%), little antipsychotic use was deemed inadequate by indication. However, the 1-year prevalence of use, dose, and duration of use of other PPMs remain high and potentially inadequate. Practitioners and policy-makers should heed both the high use and lower prescribing quality of antidepressants, anxiolytics, and sedative-hypnotics in NH residents.
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
authors.forename: Linda
authors.initials: L
authors.lastname: Simoni-Wastila
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA. Electronic address: ywei@rx.umaryland.edu.
authors.forename: Yu-Jung
authors.initials: YJ
authors.lastname: Wei
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Luong
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Franey
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
authors.forename: Ting-Ying
authors.initials: TY
authors.lastname: Huang
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; Fairleigh Dickinson University School of Pharmacy, Florham Park, NJ, USA.
authors.forename: Gail B
authors.initials: GB
authors.lastname: Rattinger
authors.affiliation: Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
authors.forename: Ilene H
authors.initials: IH
authors.lastname: Zuckerman
authors.affiliation: Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Brandt
authors.affiliation: Department of Behavioral and Community Health, Seton Hall University College of Nursing, South Orange, NJ, USA; Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Lucas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D009735:Nursing Homes / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D011787:Quality of Health Care; D014481:United States
chemical_list: D011619:Psychotropic Drugs
keywords: Nursing homes; Psychopharmacological medications; Quality of medication use