• Kate L Lapane and Carmel M Hughes.
• Center For Gerontology and Health Care Research, Department of Community Health, Brown University, Providence, Rhode Island 02912, USA. Kate_Lapane@Brown.edu
• Med Care. 2004 Oct 1; 42 (10): 992-1000.

BackgroundThere is universal agreement that organizational characteristics of nursing facilities can and do influence the quality of care and resident outcomes.ObjectiveThis study evaluated the relation between organizational characteristics and management of depression using antidepressants.Research DesignThis was a cross-sectional study of Medicare/Medicaid certified nursing homes in 6 states in 2000.SubjectsWe studied 87,907 residents with depression in 2,128 facilities.MeasuresMinimum Data Set (MDS) provided information regarding use of antidepressants and resident factors. On-line Survey and Certification of Automated Records (OSCAR) provided facility characteristics information including structural, resource, and staffing levels. Adjusted estimates of organizational effects on antidepressant drug use were derived from generalized estimating equations.ResultsIncreased treatment of depression with antidepressants was associated with facilities with a higher percentage of residents from payer sources other than Medicare/Medicaid (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.02-1.06) and more professional nursing staff (OR, 1.15; 95% CI, 1.05-1.26). Decreased treatment tended to be related to larger homes (OR, 0.76; 95% CI, 0.68-0.84) or if the home employed full-time physicians (OR, 0.87; 95% CI, 0.78-0.96). Once the decision to treat was made, treatment with tricyclics tended to be inversely related to larger homes, for-profit facilities, and homes with more Medicare residents.ConclusionsFacilities that are required to be more fiscally conservative, be it larger facilities with fewer private pay patients or for profit facilities, have lower rates of pharmacologic treatment. Resource and structural characteristics influence the type of antidepressant being prescribed; resident characteristics may not be the over-riding factor in prescribing.

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