REGULATORY ENVIRONMENT AND PSYCHOTROPIC USE IN BOARD-AND-CARE FACILITIES - RESULTS OF A 10-STATE STUDY

Background. Largely unsupervised administration of drugs and the poten tial for overuse of psychotropic agents in residential care facilities have emerged as major public polity concerns. In a large multistate s tudy, we examined patterns of psychotropic prescription and use by fac ility licensure status and the extensiveness of state regulations. Met hods. Descriptive analyses were based on a sample of 2,949 residents f rom 493 board-and-care facilities in 10 states, drawn via a complex, m ultistage sampling design. States were purposively selected based on t he stringency of their board-and-care regulatory system, and samples o f facilities were drawn, stratified by licensure status and home size. Residents were randomly selected within the sampled facilities. Weigh ted analyses were performed with Software for Survey Data Analysis (SU DAAN), accounting for the complex sampling design. Results. Approximat ely 43% of the residents were prescribed and 41% used at least one psy chotropic agent, primarily on a routinely scheduled basis. Antipsychot ics were prescribed to 22% and used by 21%: antidepressants were presc ribed to 17% and taken by 16%: antimanic agents were prescribed to and used by 4%: and anxiolytics, sedatives, or hypnotics were prescribed to 17% and used by 14%. Among psychotropic users, over 50% had not had mental health services in the prior year: 25% had no psychiatric hist ory. Among licensed facilities, prescription and use of psychotropics, particularly antipsychotics, was significantly higher among residents of homes located in states with limited regulatory systems. Conclusio ns. Results revealed high rates of psychotropic prescription and use, and not inconsequential levels of polypharmacy - within and across the rapeutic classes - among board-and-care facility residents. Frequently psychotropics were not used as an adjunct to alternative treatments, and were not associated with a psychiatric history. Extent of psychotr opic use was related to the regulatory environment, suggesting that mo re extensive regulations, and monitoring may reduce psychoactive drug use in board-and-care facilities, and more adequately ensure the appro priateness of such treatment.