Association Between Long-Term Care Facility Staffing Levels and Antipsychotic Use in US Long-Term Care Facilities |
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| Affiliation: | 1. Department of Psychiatry, Queen''s University, Providence Care-Mental Health Services, Kingston, ON, Canada;2. Department of Psychiatry, Hotchkiss Brain Institute, and O''Brien Institute for Public Health, Calgary, AB, Canada;3. Cumming School of Medicine, University of Calgary, Calgary, AB, Canada;1. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;2. Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;3. Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;4. University of North Texas Health Science Center, Fort Worth, TX, USA;1. Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia;2. Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands;3. Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;4. Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore;1. Division of Hospital Medicine, University of Colorado Denver, Aurora, CO, USA;2. University of Colorado Cancer Center, Aurora, CO, USA;3. Division of Health Care Policy and Research, University of Colorado Denver, Aurora, CO, USA;4. Division of General Internal Medicine, University of Colorado Denver, Aurora, CO, USA;1. Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX, USA;2. Department of Clinical Research and Leadership, The George Washington University, Washington, DC, USA;3. Office of Biostatistics, Department of Preventive Medicine and Public Health, University of Texas Medical Branch, Galveston, TX, USA;4. Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA;5. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA;6. Department of Nutrition, Metabolism and Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA |
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| Abstract: | ObjectivesInappropriate use of antipsychotics is an indicator of quality of care in long-term care (LTC) facilities. There is evidence to suggest that staffing levels in LTC may be associated with the rates of inappropriate antipsychotic use. This study sought to examine the association between staffing and antipsychotic prescribing in LTC facilities.DesignCross-sectional study investigated the association between reported staffing levels and the frequency of inappropriate antipsychotic prescribing at US LTC facilities between 2016 and 2018.Setting and ParticipantsData from the Nursing Home Compare and LTCFocus datasets were linked, which contain information from the Minimum Data Set database on facility characteristics and staffing measures from the Payroll-Based Journal system. A final sample set of 10,436 facilities was used.MethodsDescriptive statistics were calculated for all variables of interest. An unadjusted linear correlation analysis and linear regression were performed. Potential confounders were investigated by comparison across low-vs high-staffing facilities where adjusted for in regression analyses.ResultsThe mean staff level for the facilities was identified as 3.69 (SD = 0.67) staffing hours per patient per day, and the mean antipsychotic use rate across all facilities was 15.24% (SD = 8.62%). There was a 0.75% decrease in inappropriate antipsychotic prescribing per unit increase in overall staff-to-patient ratio. When looking at staffing types, a 3.09% decrease in inappropriate antipsychotic prescribing was observed per unit increase in licensed staff hours. More specifically, we saw a 2.25% decrease per unit increase in RN staffing hours, a 1.83% decrease per unit increase in LPN staffing hours, and nursing aide staffing hours were not associated with antipsychotic use.Conclusions and ImplicationsThese findings provide support for policy-based interventions to decrease antipsychotic use in LTC facilities by improving staffing skill mix and staffing levels. The results may also inform nursing staff education and training on antipsychotic prescribing practices. |
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| Keywords: | Quality of care staffing human resources antipsychotic nursing home long-term care |
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