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Antidepressant prescribing patterns in the nursing home: second-generation issues revisited
Shruti Shah1, Ben Schoenbachler, Joel Streim
1Department of Psychological & Brain Sciences, University of Louisville, Louisville, KY 40292, USA.
Journal of the American Medical Directors Association
|November 1, 2011
Summary
Antidepressant prescribing in nursing homes often mismatches resident depression diagnoses. Documentation quality for antidepressant management remains insufficient, highlighting a need for improved care and record-keeping in long-term care facilities.
Area of Science:
- Geriatric Medicine
- Psychopharmacology
- Health Services Research
Background:
- Nursing home residents frequently experience depression, necessitating appropriate management.
- Antidepressant use in this population requires careful consideration of diagnoses and treatment efficacy.
- Organizational and resident factors can influence the quality of care provided in nursing homes.
Purpose of the Study:
- To evaluate the current quality of antidepressant management in nursing homes.
- To assess antidepressant prescribing patterns in relation to resident diagnoses.
- To examine the impact of organizational and resident factors on antidepressant care quality.
Main Methods:
- A cross-sectional study involving chart reviews of 209 long-term care residents across 10 nursing homes.
- Utilized the Quality of Depression Management and Antidepressant Prescribing rating scale and Minimum Data Set 2.0.
- Employed Pearson correlation and chi-square analyses to examine relationships between variables.
Main Results:
- Nearly 60% of residents were prescribed antidepressants.
- A significant discrepancy was observed between depression diagnoses and antidepressant prescriptions (e.g., ~25% of diagnosed residents were not prescribed, ~33% of undiagnosed residents were prescribed).
- Documentation regarding dosing, side effects, and treatment rationale was frequently suboptimal.
Conclusions:
- Persistent discrepancies exist between antidepressant prescribing and documented depression diagnoses in nursing homes.
- The quality of antidepressant documentation in nursing home records is inadequate.
- Further research is needed to address these prescribing and documentation deficiencies.
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