Journal of the American Medical Directors Association
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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.
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Comparative Study
A comparative study of nursing home resident outcomes between care provided by nurse practitioners/physicians versus physicians only.
The objective of this study was to determine if outcomes of care for nursing home residents differ between two groups of providers: nurse practitioners/physicians and physicians only. ⋯ The level of care provided for patients by the two groups of providers was basically the same and of similar quality; however, the nurse practitioner/physician group patients were seen more often. Increased visits by nurse practitioners are assumed to result in time and cost savings for physicians and improved access to care for patients.
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The purpose of this study was to explore the feasibility of implementing two specific Clinical Practice Guidelines (CPGs), Pain Management and Falls and Fall Risk, developed by the American Medical Directors Association. ⋯ The study provides some support for the feasibility of CPG implementation in facilities that voluntarily attempted to implement the guidelines. In addition, the findings provide some useful suggestions for how to facilitate the implementation process.