Nursing homes rein in use of antipsychotic drugs

Print Friendly and PDF By: Andy Miller Published: May 7, 2013

Georgia nursing homes have cut their “off-label’’ use of antipsychotic medications by 16 percent, the biggest reduction in the nation, industry officials say.

The Centers for Medicare and Medicaid Services has pushed for a decrease in the use of antipsychotics in managing dementia patients in nursing homes.

Prescribing these drugs for behavior problems is considered “off-label’’ use, meaning they are being employed in a way that’s different from their FDA-approved purposes. Off-label prescribing is a legal and very common practice.

Yet antipsychotics increase the risk of death, falls with fractures, hospitalizations and other complications for nursing home residents, leading to high medical high costs. Roughly half of Georgia’s nursing home patients have dementia, industry officials say.

Georgia had one of the highest rates of use of antipsychotics in 2011. Only Louisiana and Tennessee exceeded Georgia’s rate of 28.9 percent of patients. The state’s current rate of 24.2 percent is still above the national average of 22.2, according to the nursing home industry, citing CMS statistics.

Over the course of 2012, Georgia nursing homes reduced the off-label use of these drugs by 16.3 percent. During the same period, the industry reduced the use of these medications nationally by 5.9 percent.

“We’re extremely encouraged to see Georgia facilities stepping up to the challenge,’’  Jon Howell, president and CEO of the Georgia Health Care Association, which represents nursing homes, told GHN on Tuesday.  “We’re proud of the results.’’

Howell noted Georgia’s high rate, saying, “Georgia had some work to do. We really wanted to address this.’’

He added that nursing homes would continue to seek reductions in this medication use, along with pursuing other initiatives to reduce hospital readmission rates; decrease staff turnover; and boost patient satisfaction.

Howell said the Georgia Health Care Association partnered with Alliant GMCF, the Medicare Quality Improvement Organization for the state, on training for those facilities that had a higher percentage of antipsychotic usage.

Kathryn Fowler of the Georgia Council on Aging told GHN on Tuesday that such drugs have been used too frequently for behavior control in nursing homes.

Research has revealed that more than one in five nursing home patients nationally receive an antipsychotic drug, generally off-label.

“The prescribing of antipsychotic medications persists at high levels in U.S. nursing homes despite extensive data demonstrating marginal clinical benefits and serious adverse effects, including death,” Becky Briesacher and colleagues at the University of Massachusetts in Worcester wrote in a research letter in the Feb. 6 issue of the Journal of the American Medical Association.

Drugs used were often from the atypical class of antipsychotics, which are primarily intended for the treatment of schizophrenia and bipolar disorder, such as Seroquel, Risperdal and Zyprexa, the Massachusetts researchers said.

In addition to dangers associated with antipsychotic medications for the elderly, use of these drugs can also be expensive to consumers and Medicare. Atypical antipsychotic medications cost more than $13 billion in 2007, nearly 5 percent of all U.S. drug expenditures, CMS has reported.

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