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Objectives: The Health Care Financing Administration requires that patients admitted to certified nursing homes be assessed with the Minimum Data Set, a data collection instrument containing more than 300 demographic, diagnostic, clinical, and treatment variables. Long-term care databases potentially may be used to assess the outcomes of specific treatments as well as drug effectiveness. The authors sought to ascertain reliability and validity of diagnostic and drug data in a database obtained by merging the Minimum Data Set with detailed information on drugs consumed by each resident., Methods: A population of 296,379 residents of 1,492 nursing homes in Kansas, Maine, Mississippi, New York, and South Dakota participated in the study between 1992 and 1994. Minimum Data Set clinical diagnoses were contrasted with selected resident characteristics and a variety of symptoms and treatments. Limited to individuals who had been hospitalized in the 6 months preceding the first assessment, Minimum Data Set diagnoses were compared with those on the hospital discharge claims maintained in the Medicare Provider Analysis and Review database. Finally, the probability that the use of selected drugs predicted the correspondent gender-specific, age-specific, or unique labeled indication was estimated., Results: The positive predictive value for Minimum Data Set diagnoses compared with gender or function measures exceeded 0.9, and it was 0.8 for specific symptoms and 0.6 for virtually all other comparisons. The positive predictive value for Minimum Data Set diagnoses compared with those from hospital claims was approximately 0.7 for all chronic medical conditions, except for depression and asthma/chronic obstructive pulmonary disease/emphysema. The positive predictive value for acute/subacute diagnoses (ie, pneumonia, urinary tract infection, anemia) that may resolve during hospital stay was less than 0.5. The positive predictive value for selected drugs, except estrogens, compared with age and gender was close to 1.0 in all cases. When compared to their labeled indication, the positive predictive value was more than 0.6 for all drugs considered, with 0.97, 0.91, and 0.87 for tacrine and Alzheimer's disease, antidiabetics and diabetes mellitus, and L-dopa and Parkinson's disease, respectively., Conclusions: These findings point to the overall validity of the drug and clinical data in this Minimum Data Set-based data set. Additional validation efforts will determine whether this data set can be used for studies of geriatric pharmacoepidemiology and for analyses of the influence of different policies and practices on residents' outcomes.

Objectives: Using 1993 data, this study examines the prevalence of presumptively inappropriate prescriptions among residents, aged 65 and older, of board and care homes., Methods: Inappropriate drug prescriptions were identified through the use of established criteria developed for application to older nursing home residents and to community-dwelling elderly. This research used a sample of 2054 elderly residents from 410 facilities in 10 states. Weighted analyses were performed with SUDAAN, which accounted for the complex, multistage sampling design., Results: Depending on the criterion applied, between 20% and 25% of residents had at least one inappropriate prescription. Propoxyphene, long-acting benzodiazepines, dipyridamole, and amitriptyline were prescribed most frequently. Residents with inappropriate drug prescriptions had more complex drug regimens prescribed on a routine basis., Conclusions: The results are a conservative estimate of the extent of inappropriate drug prescribing and utilization in board and care facilities. Increased involvement by pharmacists and physicians in systematic drug utilization review is warranted.

Background: Largely unsupervised administration of drugs and the potential for overuse of psychotropic agents in residential care facilities have emerged as major public policy concerns. In a large multistate study, we examined patterns of psychotropic prescription and use by facility licensure status and the extensiveness of state regulations.Methods: Descriptive analyses were based on a sample of 2,949 residents from 493 board-and-care facilities in 10 states, drawn via a complex, multistage sampling design. States were purposively selected based on the stringency of their board-and-care regulatory system, and samples of facilities were drawn, stratified by licensure status and home size. Residents were randomly selected within the sampled facilities. Weighted analyses were performed with Software for Survey Data Analysis (SUDAAN), accounting for the complex sampling design.Results: Approximately 43% of the residents were prescribed and 41% used at least one psychotropic agent, primarily on a routinely scheduled basis. Antipsychotics were prescribed to 22% and used by 21%; antidepressants were prescribed to 17% and taken by 16%; antimanic agents were prescribed to and used by 4%; and anxiolytics, sedatives, or hypnotics were prescribed to 17% and used by 14%. Among psychotropic users, over 50% had not had mental health services in the prior year; 25% had no psychiatric history. Among licensed facilities, prescription and use of psychotropics, particularly antipsychotics, was significantly higher among residents of homes located in states with limited regulatory systems.Conclusions: Results revealed high rates of psychotropic prescription and use, and not inconsequential levels of polypharmacy - within and across therapeutic classes - among board-and-care facility residents. Frequently, psychotropics were not used as an adjunct to alternative treatments, and were not associated with a psychiatric history. Extent of psychotropic use was related to the regulatory environment, suggesting that more extensive regulations and monitoring may reduce psychoactive drug use in board-and-care facilities, and more adequately ensure the appropriateness of such treatment. [ABSTRACT FROM AUTHOR]