EFFECTS OF A RESTRAINT REDUCTION INTERVENTION AND OBRA-87 REGULATIONSON PSYCHOACTIVE DRUG-USE IN NURSING-HOMES

OBJECTIVES: To describe the changes in psychoactive drug use in nursin g homes after implementation of physical restraint reduction intervent ions and mandates of the Omnibus Budget Reconciliation Act of 1987 (OB RA '87). METHODS: A secondary analysis was conducted using data from a controlled clinical trial that took place in three nursing homes: a c ontrol home, one that received an educational intervention, and one th at received an educational/consultation intervention. All three homes were influenced by the OBRA mandates. Complete pre- and 6 months' post -intervention data on use of psychoactive drugs and physical restraint s were available for 446 resident subjects. Changes were first analyze d with the resident subject as the unit of analysis and then using the nursing home ward (n = 16) as the unit of analysis. RESULTS: while ph ysical restraint use declined in the home that received the educationa l/consultation intervention, neither neuroleptic nor benzodiazepine us e increased in any of the homes after the interventions. The percentag e of residents taking neuroleptics declined in the control home (18.6% to 11.3%, P = .014). Benzodiazepine use, which was more prevalent tha n described previously in the literature, declined in al three homes ( P < .001). Of those residents whose physical restraints were discontin ued, only 2% were started on neuroleptics. When the effect of OBRA man dates on appropriateness of neuroleptic use was examined, the per cent age of residents on neuroleptics who lacked an OBRA-approved indicatio n declined from 21.3% to 14.6% in the total sample, and from 39.9% to 8% in the control home. CONCLUSIONS: Interventions to reduce physical restraint did not lead to an increase in psychoactive drug use; furthe r, reduction in both can occur simultaneously. OBRA. mandates regardin g psychoactive drug use were not uniformly effective, but appear, at m inimum, to have increased awareness of the indications for neuroleptic s.