Organizational Factors Associated With Inappropriate Neuroleptic Drug Prescribing in Nursing Homes: A Multilevel Approach

Abstract

Objective: To determine whether the number of attending general practitioners (GPs) in nursing homes and other facility characteristics are associated with inappropriate neuroleptic prescribing.

Design: Cross-sectional study.

Setting: One hundred seventy-five nursing homes in France participating in the IQUARE (Impact d'une démarche QUAlité sur l'évolution des pratiques et le déclin fonctionnel des Résidents en EHPAD) study.

Participants: A total of 6275 residents included between May and July 2011.

Measurements: The outcome measure was potentially inappropriate prescribing of neuroleptic drugs according to the approved indications and French guidelines. Resident characteristics and nursing home characteristics were electronically recorded by the nursing home's coordinating physician. Because of the hierarchical structure of data (resident level and nursing home level), multivariate analysis using a multilevel binary logistic model was carried out to investigate factors associated with inappropriate neuroleptic prescribing.

Results: Of 6275 residents enrolled, 1532 (24.4%) had at least 1 prescription for a neuroleptic drug. This corresponded to 513 residents (33.5%) with appropriate prescribing (with regard to indication, substance and dose) and 1019 (66.5%) with potentially inappropriate prescribing. The multilevel binary logistic model showed that residents who lived in a nursing home with 30 GPs or more/100 beds had a higher likelihood of potentially inappropriate prescription than those who lived in nursing homes with fewer than 10 GPs/100 beds [adjusted odds ratio (aOR) 1.80; 95% confidence interval (CI) 1.04-3.12]. Residents who were ≥ 85 years old and those with dementia were more likely to have inappropriate prescription (aOR 1.75; 95% CI 1.32-2.32 and aOR, 2.06; 95% CI 1.56-2.74, respectively) such as the statement "no psychotropic drug prescription," whereas the resident did in fact have a prescription (aOR 1.96; 95% CI 1.03-3.74).

Conclusions: Organizational difficulties because of a large number of physicians probably explain the association with inappropriate prescribing of neuroleptics.

Trial registration: ClinicalTrials.gov NCT01703689.

Keywords: Nursing homes; elderly; general practitioners; inappropriate prescribing; neuroleptics.