مقاله انگلیسی رایگان در مورد رابطه فرهنگ سازمانی و استفاده از داروهای روانگردان – اسپرینگر 2018

Psychotropic medicines are often prescribed in nursing homes to manage behavioral and sleep disturbances in the elderly, despite extensive data showing merely marginal clinical benefits and their association with serious harm [1–4]. Potential harmful adverse effects include falls, tardive dyskinesia, pneumonia, cognitive and functional decline, and death [4–7]. The reported frequency of psychotropic medicines use in nursing homes is 47 and 72% in Australia and the US, respectively [8, 9]. In the US, 30% of prescribed psychotropic treatments for residents in nursing homes are reported to be inappropriate, with numerous studies revealing psychotropic medicines are used longer than recommended, at high doses, or outside approved indications [9]. Additionally, residents who are prescribed psychotropic medicines are likely to remain on treatment due to the lack of reassessment, thereby exposing residents to unnecessary risks [9]. There is sufficient evidence showing variation in the level of psychotropic medicine use across nursing homes, indicating that psychotropic medicines are not prescribed solely based on resident characteristics (such as age, indication, comorbidities) and that other factors drive the high use of psychotropic medicines [10, 11]. Factors associated with the use of psychotropic medicines include nursing home characteristics such as bed capacity, staffing levels, and ownership type [12–14]. Kamble et al. [12] reported nursing homes with 200 beds or more had increased use of antipsychotic medicines. Higher nurse staffing levels are correlated with the low use of benzodiazepines [13], and for-profit operated nursing homes are associated with overall increased antipsychotic medicine use [14]. When accounting for nursing home characteristics, other studies have shown residents are likely to be prescribed an antipsychotic medicine if they enter a nursing home that has a high prescribing rate [10, 11, 15]. A number of studies have proposed organizational culture as the explanation for the normalization of psychotropic prescribing in some nursing homes, as well as the variation in psychotropic medicine use [10, 16]. These findings suggest that some nursing homes have cultures that are permissive to the use of psychotropic medicines for reasons that address the needs of staff rather than that of the resident [17]. Several interventions have been employed to safeguard residents from inappropriate prescribing that adopts a multidisciplinary professional approach, such as pharmacist-led medication reviews and multidisciplinary team meetings [18, 19]. However, previous systematic reviews also suggest culture as a factor that reflects how these interventions are actually utilized, as well as their outcomes [20–22].