An Evaluation of the Impact of the Prospective Payment System on Antidepressant Use in Nursing Home Residents

Objectives: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities on the pharmacologic treatment of depression.

Methods: We used a quasi-experimental study comparing the pharmacological treatment rates for depression in the pre-PPS period (1997) to the post-PPS period (2000) in 8149 residents with documented depression living in over 500 nursing facilities in Ohio. Logistic regression models adjusting for clustering effects of residents residing in homes using generalized estimating equations provided estimates of the PPS effect on use of any antidepressant and the use of selective serotonin reuptake inhibitors (SSRIs). We evaluated the extent to which the PPS effect was modified by organizational characteristics, including structural characteristics, resource characteristics, and staff resources available in the homes.

Results: Overall, there was no difference in the likelihood of any antidepressant [odds ratio (OR), 1.05; 95% confidence interval (CI), 0.93 to 1.18, resident-adjusted model] or an SSRI being used (OR, 0.98; 95% CI, 0.86 to 1.12, resident-adjusted model) after the introduction of PPS compared with 1997 when this reimbursement system was not in place (referent group). These trends did not appear to be modified substantially by organizational characteristics.

Conclusion: Although PPS did not appear to have influenced the treatment of depression in nursing homes, systems that provide checks and balances in relation to PPS are warranted.

The Islay wave power project: an engineering prospective

The design, construction and subsequent operation of the 75 kW oscillating water column wave power plant on the Isle of Islay has provided a significant insight into the practicality of wave power conversion. The development of wave power plant poses a significant design and construction challenge for not only civil but also mechanical and electrical engineers. The plant must withstand the immense forces imposed during storms, yet efficiently convert the slow cyclic motion of waves into a useful energy source such as electricity and do so at a price competitive with other forms of generation. In addition, the hostile marine environment hampers the construction process and the variability of the wave resource poses problems for electrical control and grid integration. Many sceptics consider wave power conversion to be too difficult, too expensive and too variable to justify the effort and expense necessary to develop this technology. However, the authors contend that with modular wave power systems developed from the practical experience gained with the Islay plant, wave power is a viable technology with a considerable world market potential. However, this technology is still at the early stages of development and will require the construction of a number of different prototypes before there is extensive commercial exploitation.