Abstract : BACKGROUND Few studies have examined factors associated with antidepressant prescribing in older nu
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Abstract : BACKGROUND Few studies have examined factors associated with antidepressant prescribing in older nursing home residents.|OBJECTIVE The primary objective was to describe the change in antidepressant prescribing for nursing home residents between 1996 and 2006. An additional objective was to examine the association between any change in antidepressant prescribing and staffing patterns or coprescribing of other psychotropic medications in the same cohort.|DESIGN Longitudinal.|SETTINGS Settings were 12556 US nursing homes in 1996 and 2006.|DATA SOURCES Online Survey Certification and Reporting (OSCAR) data and the Area Resource File (ARF).|MEASUREMENTS Increasing prescribing of antidepressants analyzed using multivariable multinomial generalized estimating equations (GEE).|RESULTS Antidepressant prescribing significantly increased (P lt .05) from 21.9 in 1996 to 47.5 in 2006. After controlling for resident organizational and market factors increased antidepressant prescribing was associated with more time spent by physician extenders (adjusted odds ratio AOR 2.21 95 confidence interval CI 1.96-2.51) registered nurses (AOR 1.06 95 CI 1.02-1.10) or nurse aides (AOR 1.08 95CI 1.04-1.12) in a facility as well as the coprescribing of sedative/hypnotics (AOR 1.12 95 CI 1.08-1.16). Factors found to be protective of increasing antidepressant prescribing (ie decrease antidepressant prescribing) included having medical directors and physicians spend more time in the facility (AOR 0.60 95 CI 0.53-0.69 and AOR 0.62 95 CI 0.54-0.71 respectively) or coprescribing of antianxiety or antipsychotic agents (AOR 0.70 95 CI 0.68-0.72 and AOR 0.74 95 CI 0.72-0.77 respectively).|CONCLUSIONS: Prescribing of antidepressants has increased dramatically in the past decade in older nursing home residents and seems to be associated with certain staffing characteristics and the coprescribing of psychotropic medications. Further research is needed to determine if antidepressants are appropriately prescribed, and if overuse is determined, develop interventions to improve the quality of prescribing of these medications in older nursing home residents.|
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