Claudia H W Smeets1,2, Debby L Gerritsen1,2, Sytse U Zuidema3, Steven Teerenstra4, Klaas van der Spek1,2, Martin Smalbrugge5, Raymond T C M Koopmans1,2,6. 1. a Department of Primary and Community Care, Center for Family Medicine, Geriatric Care and Public Health , Radboud university medical center , Nijmegen , The Netherlands. 2. b Alzheimer Center , Radboud university medical center , Nijmegen , The Netherlands. 3. c Department of General Practice, University Medical Center Groningen , University of Groningen , Groningen , The Netherlands. 4. d Section Biostatistics, Department of Health Evidence, Radboud Institute for Health Sciences , Radboud university medical center , Nijmegen , The Netherlands. 5. e Department of General Practice and Elderly Care Medicine/ EMGO+ Institute for Health and Care Research , VU Medical Center , Amsterdam , The Netherlands. 6. f Joachim en Anna, Center for Specialized Geriatric Care , Nijmegen , The Netherlands.
Abstract
OBJECTIVES: To determine psychotropic drug prescription rates in nursing home residents with dementia and to identify associations with the so far understudied psychosocial non-resident-related factors. METHOD: A cross-sectional, observational, exploratory design as part of PROPER I (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia). Participants were 559 nursing home residents with dementia, 25 physicians, and 112 nurses in the Netherlands. Psychotropic drug prescription, non-resident-related and known resident-related variables were measured to operationalize the themes of our previous qualitative analysis. RESULTS: Fifty-six percent of residents were prescribed any psychotropic drug, 25% antipsychotics, 29% antidepressants, 15% anxiolytics, and 13% hypnotics, with large differences between the units. Multivariate multilevel regression analyses revealed that antipsychotic prescription was less likely with higher physicians' availability (odds ratio 0.96, 95% confidence interval 0.93-1.00) and that antidepressant prescription was more likely with higher satisfaction of nurses on resident contact (odds ratio 1.50, 95% confidence interval 1.00-2.25). Resident-related factors explained 6%-15% of the variance, resident- and non-resident-related factors together 8%-17%. CONCLUSION: Prescription rates for antipsychotics are similar compared to other countries, and relatively low for antidepressants, anxiolytics, and hypnotics. Our findings indicate that improvement of prescribing could provisionally best be targeted at resident-related factors.
OBJECTIVES: To determine psychotropic drug prescription rates in nursing home residents with dementia and to identify associations with the so far understudied psychosocial non-resident-related factors. METHOD: A cross-sectional, observational, exploratory design as part of PROPER I (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia). Participants were 559 nursing home residents with dementia, 25 physicians, and 112 nurses in the Netherlands. Psychotropic drug prescription, non-resident-related and known resident-related variables were measured to operationalize the themes of our previous qualitative analysis. RESULTS: Fifty-six percent of residents were prescribed any psychotropic drug, 25% antipsychotics, 29% antidepressants, 15% anxiolytics, and 13% hypnotics, with large differences between the units. Multivariate multilevel regression analyses revealed that antipsychotic prescription was less likely with higher physicians' availability (odds ratio 0.96, 95% confidence interval 0.93-1.00) and that antidepressant prescription was more likely with higher satisfaction of nurses on resident contact (odds ratio 1.50, 95% confidence interval 1.00-2.25). Resident-related factors explained 6%-15% of the variance, resident- and non-resident-related factors together 8%-17%. CONCLUSION: Prescription rates for antipsychotics are similar compared to other countries, and relatively low for antidepressants, anxiolytics, and hypnotics. Our findings indicate that improvement of prescribing could provisionally best be targeted at resident-related factors.
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