The impact of OBRA-87 on psychotropic drug prescribing in skilled nursing facilities

Borson, Soo; Doane, K W

doi:10.1176/ps.48.10.1289

Cited by 38 publications

(4 citation statements)

References 38 publications

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“…In the US, considerable inter-facility and inter-state variation exists in the rates of physical restraint and antipsychotic use, but their overall prevalence has declined appreciably in recent years, owing in large part to the restraint reduction requirements mandated by OBRA-87 (Semla et al ., 1994; Shorr et al ., 1994; Garrard et al ., 1995; Lantz et al ., 1996; Borson and Doane, 1997; Castle, 1998; Castle and Mor, 1998; Wiener et al ., 2007a). Another evaluation of the impact of legislation on psychotropic drug use concluded that regulatory policies have had an impact on the prescribing of psychotropic medications in US nursing homes compared with five other OECD countries with no similar regulation (Hughes et al ., 2000).…”

Section: Discussionmentioning

confidence: 99%

Use of physical restraints and antipsychotic medications in nursing homes: a cross‐national study

Feng

Hirdes

Smith

et al. 2009

Int J Geriat Psychiatry

153

138

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SUMMARY Objectives This study compares inter- and intra-country differences in the prevalence of physical restraints and antipsychotic medications in nursing homes, and examines aggregated resident conditions and organizational characteristics correlated with these treatments. Methods Population-based, cross-sectional data were collected using a standardized Resident Assessment Instrument (RAI) from 14,504 long-term care facilities providing nursing home level services in five countries participating in the interRAI consortium, including Canada, Finland, Hong Kong (Special Administrative Region, China), Switzerland, and the United States. Facility-level prevalence rates of physical restraints and antipsychotic use were examined both between and within the study countries. Results The prevalence of physical restraint use varied more than five-fold across the study countries, from an average 6% in Switzerland, 9% in the US, 20% in Hong Kong, 28% in Finland, and over 31% in Canada. The prevalence of antipsychotic use ranged from 11% in Hong Kong, between 26–27% in Canada and the US, 34% in Switzerland, and nearly 38% in Finland. Within each country, substantial variations existed across facilities in both physical restraint and antipsychotic use rates. In all countries, neither facility case mix nor organizational characteristics were particularly predictive of the prevalence of either treatment. Conclusions There exists large, unexplained variability in the prevalence of physical restraint and antipsychotic use in nursing home facilities both between and within countries. Since restraints and antipsychotics are associated with adverse outcomes, it is important to understand the idiosyncratic factors specific to each country that contribute to variation in use rates.

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Section: Discussionmentioning

confidence: 99%

Use of physical restraints and antipsychotic medications in nursing homes: a cross‐national study

Feng

Hirdes

Smith

et al. 2009

Int J Geriat Psychiatry

153

138

View full text Add to dashboard Cite

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“…The impact of regulatory interventions such as restriction of SH prescription conditions was assessed in 8 studies [ 45 , 47 , 50 , 53 , 55 , 56 , 58 , 67 ]. Regulatory strategies were managed by national or local authorities and were directed toward physicians.…”

Section: Resultsmentioning

confidence: 99%

“…Positive results were reported in 7 out of the 8 studies assessing regulatory interventions [ 45 , 47 , 50 , 55 , 56 , 58 , 67 ]. Ending of reimbursement and restriction of prescription rules were presented as effective strategies to reduce the prescription and/or the consumption of targeted SHs (up to 85%).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of regulatory and educational interventions to reduce the burden associated with the prescriptions of sedative-hypnotics in adults treated for sleep disorders

et al. 2018

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BackgroundThe burden of Sedative-Hypnotics (SHs) has been known since the 1980s. Yet, their consumption remains high. A systematic review of the literature should help to assess efficient interventions to improve the appropriate use of SHs in sleep disorders.ObjectivesTo identify and assess regulatory and educational interventions designed to improve the appropriate use of SHs for insomnia treatment.MethodsWe conducted a systematic review of the literature according to PRISMA guidelines. A systematic search covering the period 1980–2015 was carried out in Medline, Web of Science, Embase and PsycInfo. We included studies reporting the implementation of regulatory or educational strategies directed towards patients and/or healthcare professionals to improve the appropriate use of SHs to treat insomnia in the community, hospitals and nursing homes.ResultsThirty-one studies were included: 23 assessed educational interventions (recommendations by mail/email, computer alerts, meetings, mass media campaigns, prescription profile), 8 assessed regulatory interventions (prescription rule restriction, end of reimbursement). The most recent was implemented in 2009. Restrictive prescription rules were effective to reduce the consumption of targeted SHs but led to a switch to other non-recommended SHs. Among educational interventions, only 3 studies out of 7 reported positive results of mono-faceted interventions; whereas, 13 out of the 16 multi-faceted interventions were reported as efficient: particularly, the active involvement of healthcare professionals and patients and the spread of information through mass media were successful. The risk of bias was high for 24 studies (mainly due to the design), moderate for 3 studies and weak for 4 studies.ConclusionEducational multifaceted studies are presented as the most efficient. But further better designed studies are needed to make evidence-based results more generalizable.

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“…The Omnibus Budget Reconciliation Act of 1987 in the USA succeeded in decreasing the use of harmful psychiatric medications among older people [17]. There have been warnings concerning the use of antipsychotics in patients with dementia, with an increased risk of stroke and mortality [18,19].…”

Section: Introductionmentioning

confidence: 99%

Reducing inappropriate, anticholinergic and psychotropic drugs among older residents in assisted living facilities: study protocol for a randomized controlled trial

Pitkälä

Juola

Soini³

et al. 2012

Trials

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BackgroundUse of inappropriate drugs is common among institutionalized older people. Rigorous trials investigating the effect of the education of staff in institutionalized settings on the harm related to older people’s drug treatment are still scarce. The aim of this trial is to investigate whether training professionals in assisted living facilities reduces the use of inappropriate drugs among residents and has an effect on residents’ quality of life and use of health services.Methods and designDuring years 2011 and 2012, a sample of residents in assisted living facilities in Helsinki (approximately 212) will be recruited, having offered to participate in a trial aiming to reduce their harmful drugs. Their wards will be randomized into two arms: one, those in which staff will be trained in two half-day sessions, including case studies to identify inappropriate, anticholinergic and psychotropic drugs among their residents, and two, a control group with usual care procedures and delayed training. The intervention wards will have an appointed nurse who will be responsible for taking care of the medication of the residents on her ward, and taking any problems to the consulting doctor, who will be responsible for the overall care of the patient. The trial will last for twelve months, the assessment time points will be zero, six and twelve months.The primary outcomes will be the proportion of persons using inappropriate, anticholinergic, or more than two psychotropic drugs, and the change in the mean number of inappropriate, anticholinergic and psychotropic drugs among residents. Secondary endpoints will be, for example, the change in the mean number of drugs, the proportion of residents having significant drug-drug interactions, residents' health-related quality of life (HRQOL) according to the 15D instrument, cognition according to verbal fluency and clock-drawing tests and the use and cost of health services, especially hospitalizations.DiscussionTo our knowledge, this is the first large-scale randomized trial exploring whether relatively light intervention, that is, staff training, will have an effect on reducing harmful drugs and improving QOL among institutionalized older people.Trial registrationACTRN12611001078943

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The impact of OBRA-87 on psychotropic drug prescribing in skilled nursing facilities

Cited by 38 publications

References 38 publications

Use of physical restraints and antipsychotic medications in nursing homes: a cross‐national study

Use of physical restraints and antipsychotic medications in nursing homes: a cross‐national study

A systematic review of regulatory and educational interventions to reduce the burden associated with the prescriptions of sedative-hypnotics in adults treated for sleep disorders

Reducing inappropriate, anticholinergic and psychotropic drugs among older residents in assisted living facilities: study protocol for a randomized controlled trial

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