A 10-YEAR REVIEW OF THE EFFECT OF OBRA-87 ON PSYCHOTROPIC PRESCRIBINGPRACTICES IN AN ACADEMIC NURSING-HOME

Objective: The Omnibus Budget Reconciliation Act of 1987 (OBRA-87) inc luded provisions for regulating the use of psychotropic medication, pa rticularly antipsychotics, in long-term-care facilities. The study exa mined the effect of OBRA-87 on patterns of prescribing of psychotropic medication in a 514-bed nursing home affiliated with a large medical school. Methods: Computerized pharmacy records for the ten-year period from March 1984 through July 1994 were retrospectively reviewed to id entify orders written for psychotropic medications and to determine th e percentage of nursing home residents who received prescriptions for those agents and the average daily dose of the most frequently prescri bed agents. Results: During the period before implementation of the re gulations, the percentages of residents who received antidepressants, anxiolytic and sedative-hypnotic medications, and antipsychotic medica tions were stable. After implementation, prescription of antidepressan ts increased significantly, coinciding with a reduction in prescriptio n of anxiolytics and sedative-hypnotics and a substantial decrease in prescription of antipsychotics, The total number of residents who rece ived any type of psychotropic medication decreased, and over time a tr end toward prescription of agents recommended for geriatric use, such as short-acting benzodiazepines and tertiary tricyclic antidepressants , emerged. Conclusions: The changes that resulted from the OBRA-87 reg ulations reflect both the restrictions placed on classes of medication and the prevalence of psychiatric disorders in the nursing home. In t his facility, OBRA-87 appears to have served as an impetus for clinica l review and change in practice style.