Urban rural differences in amitriptyline use among nursing facility residents

Abstract

Objective
To characterize patterns of amitriptyline use across the urban-rural continuum.

Design
Retrospective analysis of antidepressant drug codes and demographic and clinical data from the Minimum Data Set (MDS), 1994 to 1997.

Setting
Kansas nursing facilities.

Participants
Facility residents aged 65 and older.

Measures
A four-strata system was used to classify nursing facility location by county, from urban to frontier. We examined admission use and after-admission use of amitriptyline across strata for each year separately. Unadjusted and adjusted odds ratios were determined for each stratum, using the urban stratum as the point of reference.

Results
Admission use of amitriptyline occurred in 2.3 to 4% of all admissions, and although such use was highest in the most rural stratum, no clear urban-rural gradient was found. In contrast, amitriptyline use 30 days or more after admission demonstrated modest urban-rural gradients in unadjusted and adjusted analyses. In 1997, when adjusted for demographic factors, odds ratios for amitriptyline use were 2.10 (1.54–2.87), 1.68 (1.33–2.13), and 1.49 (1.17–1.90) for the Frontier, Rural, and Densely Settled Rural categories as compared with the Urban reference group.

Conclusions
After admission to Kansas nursing facilities, rural practice patterns for amitriptyline use are less favorable than those in urban areas, and an urban-rural gradient is identified. Further work is needed to identify explanatory patient, facility, and prescriber factors.