Background: The aim of this study is to assess the utilization of sedative drugs in nursing homes
by means of a multilevel approach taking into account individual as well as institutional
characteristics. Methods: A retrospective chart review of the drugs consumed in nursing homes in an urban
region of Germany was conducted. Individual characteristics were measured by analyzing
nursing home files, by staff assessment and by a structured interview conducted by
trained psychologists and physicians. Institutional characteristics were assessed
by interviewing the management of each facility and ward and by using a staff questionnaire
survey. The sample consisted of 1903 residents from 27 nursing homes with a total
of 96 wards. Data analysis was carried out by means of a multilevel analysis, a strategy
for analyzing hierarchically structured data. Results: The utilization of sedative drugs (low potency neuroleptics, anxiolytics, hypnotics)
in nursing homes is remarkably high. Thus, 33.3 % of the residents used sedative drugs
on a regular basis. PRN prescriptions existed for 13.1 % of the residents, 5.3 % had
been using sedative medication prescribed as PRN. Results indicate the influence of
individual as well as institutional characteristics on residents’ sedative drug utilization.
In particular, the use of PRN medicine is determined by characteristics of the ward
the individuals are living in. Conclusion: Methodological implications: The data analysis concerning the drug utilization of
residents of nursing homes requires multilevel models and a distinction between regular
and PRN medicine. Further research should focus on explaining institutional variance.
Practical implications: Staff training in nonpharmacological strategies to manage
disturbing behavior of residents is required.
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Prof. Dr. med. Steffi G. Riedel-Heller, MPH
Department of Psychiatry
University of Leipzig
Johannisallee 20
04317 Leipzig
Germany
Phone: +49 341 9724530
Fax: +49 341 9724539
Email: ries@medizin.uni-leipzig.de
