title: Is psychotropic medication use related to organisational and treatment culture in residential care.
abstract: OBJECTIVE
  The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care.
  
  
  METHODS
  Cross-sectional analyses of staff and resident's record survey in residential aged care facilities in Auckland, New Zealand (NZ). The competing values framework categorised organisational culture as clan, hierarchical, market driven or adhocracy and was completed by all staff. The treatment culture tool categorised facilities as having resident centred or traditional culture and was completed by registered nursing staff and general practitioners (GP). Functional and behavioural characteristics of residents were established by staff report and health characteristics and medications used were ascertained from the health record. Multiple regression was used to test for associations between measures of culture with psychotropic medication use (anxiolytics, sedatives, major tranquillisers).
  
  
  RESULTS
  In total 199 staff, 27 GP and 527 residents participated from 14 facilities. On average 8.5 medications per resident were prescribed and 42 per cent of residents received psychotropic medication. Having a diagnosis of anxiety or depression (odds ratio (OR) 3.18, 95 per cent confidence interval (CI) 1.71, 5.91), followed by persistent wandering (OR 2.53, 95 per cent CI 1.59, 4.01) and being in a dementia unit (OR 2.45, 95 per cent CI 1.17, 5.12) were most strongly associated with psychotropic use. Controlling for resident- and facility-level factors, health care assistants' assignation of hierarchical organisational culture type was independently associated with psychotropic medication use, (OR 1.29, CI 1.08, 1.53) and a higher treatment culture score from the GP was associated with lower use of psychotropic medication (OR 0.95, CI 0.92, 0.98).
  
  
  CONCLUSIONS
  Psychotropic medication use remains prevalent in residential care facilities in NZ. Interventions aimed at changing organisational culture towards a less hierarchical and more resident-centred culture may be another avenue to improve prescribing in residential aged care.
authors.affiliation: School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Peri
authors.forename: Ngaire
authors.initials: N
authors.lastname: Kerse
authors.forename: Simon
authors.initials: S
authors.lastname: Moyes
authors.forename: Shane
authors.initials: S
authors.lastname: Scahill
authors.forename: Charlotte
authors.initials: C
authors.lastname: Chen
authors.forename: Jae Beom
authors.initials: JB
authors.lastname: Hong
authors.forename: Carmel M
authors.initials: CM
authors.lastname: Hughes
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D006707:Homes for the Aged; D006801:Humans; D008485:Medical Audit; D009520:New Zealand; D009735:Nursing Homes; D015279:Organizational Culture; D018802:Patient-Centered Care; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012044:Regression Analysis
chemical_list: D011619:Psychotropic Drugs
keywords: Anxiety; Dementia; Depression; Nursing homes; Organizational culture; Patient-focused care; Pharmaceuticals; Psychotropic medication