title: Antipsychotic use in nursing homes varies by psychiatric consultant.
abstract: BACKGROUND
  The relationship between psychiatric consultation and antipsychotic prescribing in nursing homes (NH) is unknown.
  
  
  OBJECTIVE
  To identify the association between psychiatric consultant groups and NH-level antipsychotic prescribing after adjustment for resident case-mix and facility characteristics.
  
  
  METHODS
  Nested cross-sectional study of 60 NHs in a cluster randomized trial. We linked facility leadership surveys to October 2009-September 2010 Minimum Data Set, Nursing Home Compare, the US Census, and pharmacy dispensing data.
  
  
  METHODS
  The main exposure is the psychiatric consultant group and the main outcome is NH-level prevalence of atypical antipsychotic use. We calculated annual means and interquartile ranges of NH-level antipsychotic use for each consultant group and arrayed consultant groups from lowest to highest prevalence. Generalized linear models were used to predict antipsychotic prescribing adjusting for resident case-mix and facility characteristics. Observed versus predicted antipsychotic prescribing levels were compared for each consultant group.
  
  
  RESULTS
  Seven psychiatric consultant groups served a range of 3-27 study facilities. Overall mean facility-level antipsychotic prescribing was 19.2%. Mean prevalence of antipsychotic prescribing ranged from 12.2% (SD, 5.8) in the lowest consultant group to 26.4% (SD, 3.6) in the highest group. All facilities served by the highest-ranked consultant group had observed antipsychotic levels exceeding the overall study mean with half exceeding predictions for on-label indications, whereas most facilities served by the lowest-ranked consultant group had observed levels below the overall study and predicted means.
  
  
  CONCLUSIONS
  Preliminary evidence suggests that psychiatric consultant groups affect NH antipsychotic prescribing independent of resident case-mix and facility characteristics.
authors.affiliation: *University of Massachusetts Medical School †Meyers Primary Care Institute, Worcester, MA ‡Qualidigm, Wethersfield, CT §Massachsuetts College of Pharmacy and Health Sciences, Worcester, MA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Tjia
authors.forename: Terry
authors.initials: T
authors.lastname: Field
authors.forename: Celeste
authors.initials: C
authors.lastname: Lemay
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mazor
authors.forename: Michelle
authors.initials: M
authors.lastname: Pandolfi
authors.forename: Ann
authors.initials: A
authors.lastname: Spenard
authors.forename: Shih-Yieh
authors.initials: SY
authors.lastname: Ho
authors.forename: Abir
authors.initials: A
authors.lastname: Kanaan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Donovan
authors.forename: Jerry H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: Becky
authors.initials: B
authors.lastname: Briesacher
mesh_terms: D000368:Aged; D014150:Antipsychotic Agents / Q000008:administration & dosage*; D003253:Consultants / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; 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; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015995:Prevalence; D011570:Psychiatry / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data
chemical_list: D014150:Antipsychotic Agents