Journal of the American Medical Directors Association
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Multicenter Study
Barriers to timely care of acute infections in nursing homes: a preliminary qualitative study.
During a large prospective study of lower respiratory infections in nursing home residents, project staff observed that in some facilities there was consistent difficulty in obtaining timely identification of potential subjects. Starting with this motivation, we conducted a preliminary qualitative study to investigate the process of illness identification and initiating management in episodes of acute infection. We sought factors promoting timely or delayed identification and treatment of acute infections among nursing home residents. ⋯ Effective identification and management of acute infections requires successful communication at multiple levels; however, breakdowns are common. Our model provides a framework for improving acute illness care in nursing homes, which offers important insights potentially useful in quality improvement activities in nursing homes and may facilitate further research.
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Multicenter Study
Preventing assaults by nursing home residents: nursing assistants' knowledge and confidence-a pilot study.
To describe the frequency and context of assaults against nursing assistants (NAs) from residents and to describe NAs' beliefs about their violence prevention knowledge and self-efficacy to prevent assaults from residents. ⋯ These findings provide useful information that supports the need for violence prevention education and for developing violence prevention programs in nursing homes.
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Comparative Study
Prescription analgesic and antidepressant utilization and cost among elderly Medicaid beneficiaries before and after nursing home admission.
The objectives of this study were to describe changes in prescription analgesic and antidepressant medications and to track the costs associated with these medication changes when elderly Medicaid beneficiaries move from the community to a nursing home setting. ⋯ We draw three major conclusions: (1) community-dwelling elderly Medicaid beneficiaries in this study use more prescription analgesics and antidepressants than community-dwelling elders in prior studies; (2) there is a significant increase in medication utilization and cost on nursing home admission; and (3) significant variability in medication use and cost exists among the three states examined. Further investigation to elucidate the reasons for these differences could assist legislators in formulating sound public policy to contain Medicaid expenditures without sacrificing patient care.
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Multicenter Study
Antibiotic prescribing and outcomes following treatment of symptomatic urinary tract infections in older women.
To describe antibiotic prescribing patterns for the treatment of urinary tract infections (UTI) among older women female long-term care facility residents and evaluate factors associated with adverse outcomes. ⋯ Nursing home residents with UTI are treated for longer durations than community elderly. They experience a greater likelihood of receiving antibiotics in excessive dosage, a greater likelihood of adverse drug events, and a greater likelihood of retreatment compared with community subjects with UTI.