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Urban-rural differences in amitriptyline use among nursing facility residents
Sally K Rigler1, Dennis Wallace, Stephanie Studenski
1Department of Internal Medicine, and Center on Aging, University of Kansas School of Medicine, Kansas City, Kansas 66160-7376, USA.
Objective:
To characterize patterns of amitriptyline use across the urban-rural continuum.
Design:
Retrospective analysis of antidepressant drug codes and demographic and clinical data from the Minimum Data Set (MDS), 1994 to 1997.
Setting:
Kansas nursing facilities.
Participants:
Facility residents aged 65 and older.
Measures:
A four-strata system was used to classify nursing facility location by county, from urban to frontier. We examined admission use and after-admission use of amitriptyline across strata for each year separately. Unadjusted and adjusted odds ratios were determined for each stratum, using the urban stratum as the point of reference.
Results:
Admission use of amitriptyline occurred in 2.3 to 4% of all admissions, and although such use was highest in the most rural stratum, no clear urban-rural gradient was found. In contrast, amitriptyline use 30 days or more after admission demonstrated modest urban-rural gradients in unadjusted and adjusted analyses. In 1997, when adjusted for demographic factors, odds ratios for amitriptyline use were 2.10 (1.54-2.87), 1.68 (1.33-2.13), and 1.49 (1.17-1.90) for the Frontier, Rural, and Densely Settled Rural categories as compared with the Urban reference group.
Conclusions:
After admission to Kansas nursing facilities, rural practice patterns for amitriptyline use are less favorable than those in urban areas, and an urban-rural gradient is identified. Further work is needed to identify explanatory patient, facility, and prescriber factors.