Influence of facility characteristics on use of antipsychotic medications in nursing homes

OBJECTIVES. This study investigated the effect of facility and resident cha racteristics on the use of antipsychotic medications in the long-term care setting. RESEARCH DESIGN. This research used data available from the On-Line Survey and Certification of Automated Records (OSCAR) for all Medicare/Medicaid-ce rtified nursing homes in the contiguous United States in 1997. The data con sisted of 14,631 facilities. MEASURES. A multiple linear regression model was used to determine the effe cts of selected facility and resident characteristics on antipsychotic drug use while simultaneously controlling for the effects of resident character istics and stratifying by ownership type. beta -Coefficients provided measu res of effect and represented the per-unit change in the prevalence of anti psychotic use corresponding to the per-unit change in each independent vari able. RESULTS. In for-profit facilities, both the presence of special care units and mental health professionals were associated with increased antipsychoti c use (beta = 1.70, SE = 0.23; beta = 0.24 SE = 0.17, respectively), while other facility factors such as increasing size, being part of a chain, and higher occupancy rate were associated with decreased antipsychotic drug use . In the nonprofit environment, facility characteristics (eg, increasing oc cupancy rate, certified nurses' aides per 100 beds) were associated with de creasing antipsychotic use. Increasing percentages of residents covered by Medicare, those with dementia, and residents with mental retardation (beta = 0.05, SE = 0.01; beta = 0.03, SE = 0.01; beta = 0.08, SE = 0.08, respecti vely) were predictive of increased drug use. CONCLUSIONS. Facility and resident characteristics are associated with use of antipsychotic medications, although the extent to which these factors ex plain variability in use of antipsychotics may vary on the basis of the und erlying financial incentives of the institution.