Is psychotropic medication use related to organisational and treatment culture in residential care
Journal of Health Organization and Management
ISSN: 1477-7266
Article publication date: 16 November 2015
Abstract
Purpose
The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care.
Design/methodology/approach
Cross-sectional analyses of staff and resident’s record survey in residential aged care facilities in Auckland, New Zealand (NZ). The competing values framework categorised organisational culture as clan, hierarchical, market driven or adhocracy and was completed by all staff. The treatment culture tool categorised facilities as having resident centred or traditional culture and was completed by registered nursing staff and general practitioners (GP). Functional and behavioural characteristics of residents were established by staff report and health characteristics and medications used were ascertained from the health record. Multiple regression was used to test for associations between measures of culture with psychotropic medication use (anxiolytics, sedatives, major tranquillisers).
Findings
In total 199 staff, 27 GP and 527 residents participated from 14 facilities. On average 8.5 medications per resident were prescribed and 42 per cent of residents received psychotropic medication. Having a diagnosis of anxiety or depression (odds ratio (OR) 3.18, 95 per cent confidence interval (CI) 1.71, 5.91), followed by persistent wandering (OR 2.53, 95 per cent CI 1.59, 4.01) and being in a dementia unit (OR 2.45, 95 per cent CI 1.17, 5.12) were most strongly associated with psychotropic use. Controlling for resident- and facility-level factors, health care assistants’ assignation of hierarchical organisational culture type was independently associated with psychotropic medication use, (OR 1.29, CI 1.08, 1.53) and a higher treatment culture score from the GP was associated with lower use of psychotropic medication (OR 0.95, CI 0.92, 0.98).
Originality/value
Psychotropic medication use remains prevalent in residential care facilities in NZ. Interventions aimed at changing organisational culture towards a less hierarchical and more resident-centred culture may be another avenue to improve prescribing in residential aged care.
Keywords
Acknowledgements
The authors are grateful to the facilities’ staff, residents and family for their time and attention to this project. The project was funded by a grant from the Auckland District Health Board and two University of Auckland, Faculty of Medical and Health Sciences summer studentships (Charlotte Chen and Jae Beom Hong). Dr Shane Scahill is now a Senior Lecturer at the School of Management, Massey University, Auckland, New Zealand.
Conflict of interest: Ngaire Kerse has delivered medical services as a General Practitioner to residential care for many years, not to any of the facilities involved in this research. There are no other conflicts of interest to declare.
Citation
Peri, K., Kerse, N., Moyes, S., Scahill, S., Chen, C., Hong, J.B. and Hughes, C.M. (2015), "Is psychotropic medication use related to organisational and treatment culture in residential care", Journal of Health Organization and Management, Vol. 29 No. 7, pp. 1065-1079. https://doi.org/10.1108/JHOM-10-2013-0236
Publisher
:Emerald Group Publishing Limited
Copyright © 2015, Emerald Group Publishing Limited