The impact of OBRA-87 on psychotropic drug prescribing in skilled nursing facilities
OBJECTIVES: This study examined the impact of regulations established by the Omnibus Budget Reconciliation Act of 1987 (OBRA-87) on prescriptions for psychotropic drugs, and on research on their use in nursing homes. METHODS: Data were collected on drugs prescribed for residents of 39 skilled nursin...
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Veröffentlicht in: | Psychiatric services (Washington, D.C.) D.C.), 1997-10, Vol.48 (10), p.1289-1296 |
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Zusammenfassung: | OBJECTIVES: This study examined the impact of regulations established by
the Omnibus Budget Reconciliation Act of 1987 (OBRA-87) on prescriptions
for psychotropic drugs, and on research on their use in nursing homes.
METHODS: Data were collected on drugs prescribed for residents of 39
skilled nursing facilities over the four-year period from 1989 to 1992,
bracketing the implementation of OBRA-87 in the fall of 1990. Changes in
prescribing patterns were analyzed by drug class, specific target
medications and doses, number of drugs prescribed, and multidrug
combinations. To determine the effect of OBRA-87 on research, peer-reviewed
journals were searched for the number and content of publications on
psychotropic drug use in skilled nursing facilities between 1980 and 1996.
RESULTS: The number of prescriptions for antipsychotics, sedative
antihistamines, and sedative-hypnotics decreased significantly, while
prescribing of anxiolytics increased. Qualitative, but not quantitative,
shifts occurred in prescriptions for antidepressant drugs, the most
frequently used psychotropic medications in all years. Rates of
psychotropic polypharmacy remained stable. The number of data-based
publications on psychotropic drug use in nursing homes increased after
implementation of OBRA-87, but few were related to the effectiveness of
drug treatment. CONCLUSIONS: Implementation of OBRA-87's nursing home
regulations was associated with reductions in use of drugs specifically
targeted by this legislation and was a potent stimulus to research, an
unanticipated benefit of legislative action. Increased use of anxiolytics,
persistent prescribing of anticholinergic antidepressants, enthusiastic
adoption of new agents despite a limited research database involving frail
patients, and the paucity of new studies reporting data on clinical
effectiveness suggest a need for targeted research on treatment outcomes to
improve the care of this population. |
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ISSN: | 1075-2730 1557-9700 |
DOI: | 10.1176/ps.48.10.1289 |