One in 5 of the 1.4 million US nursing home residents receive antipsychotic drugs to manage dementia despite extensive evidence of marginal benefits and serious adverse effects including death. The Centers for Medicare and Medicaid Services recently launched a national campaign to reduce unnecessary prescribing of antipsychotics in the elderly but concerns have been raised that the initiative did more harm than good. The objectives of this study are to describe the current landscape of antipsychotic use in the nursing home setting and estimate how the antipsychotic reduction campaign influenced prescribing. A unique aspect of this study is to examine the extent of therapeutic substitution with medications that are not effective at managing dementia. We will also examine changes in important health outcomes such as behavioral symptoms and hospitalization. To complete these objectives, this research project will analyze an existing dataset of nursing home resident care plans linked to Medicare program data including Part D drug claims. This project should be in a unique position to inform the Medicare program and policymakers about the experience of nursing home residents related to antipsychotics and how to improve dementia care in nursing homes.
Off-label use of antipsychotic medications in the nursing home setting is common. This occurs despite a growing evidence base which highlights safety concerns and low efficacy. A recent federal campaign to reduce antipsychotic prescribing has been linked to unintended consequences including therapeutic substitution with ineffective drugs. This study is a first step to explore antipsychotic use and therapeutic substitution before and after the reduction campaign. Understanding the consequences of targeted prescribing initiatives will provide needed information to improve dementia care in nursing homes.
| Olivieri-Mui, Brianne L; Devlin, John W; Ochoa, Aileen et al. (2018) Perceptions vs. evidence: therapeutic substitutes for antipsychotics in patients with dementia in long-term care. Aging Ment Health 22:544-549 |
