Antipsychotic Use Drops In State Nursing Homes, New Data Show

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Connecticut still ranks high among states in the use of antipsychotic drugs for elderly nursing home residents, but its rate of use has dropped 21.6 percent since 2011 – more than the national average — new government data show.

The data, released Friday by the Centers for Medicare & Medicaid Services (CMS), show that nursing home residents in Connecticut – many with dementia — are still more likely to be given antipsychotics than their counterparts in 33 other states. But the state’s usage rate has declined more than the national average drop of 17.1 percent.

“While quality improvement in the area of reducing off-label antipsychotic drug usage needs to be an ongoing effort, Connecticut’s skilled nursing facilities have achieved very positive change,” said Matt Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes. He said the state’s homes are making ongoing changes in “behavioral and health care practice” to further reduce reliance on antipsychotics.

Antipsychotic drugs are an important treatment for patients with certain mental health conditions, such as schizophrenia. But the Food and Drug Administration has warned that the drugs have potentially fatal side effects when used in elderly patients with dementia. Still, nursing homes use the drugs “off-label” to calm patients who are agitated or confused.

Anti-pyschoticConcerned about the drugs’ overuse, federal regulators in 2012 announced a national initiative to slash their inappropriate use in nursing homes, with a goal of a 15 percent reduction by the end of 2012. That goal wasn’t met until the end of 2013.

On Friday, CMS – working with a coalition of providers and advocacy groups — set new goals of a 25 percent reduction by the end of 2015, and a 30 percent reduction by the end of 2016, compared to the baseline 2011 rate.

“We know that many of the diagnoses in nursing home residents do not merit antipsychotics, but they were being used anyway,” said Dr. Patrick Conway, CMS’ deputy administrator for innovation and quality and chief medical officer.

He said CMS has set “ ambitious goals” to reduce antipsychotic prescribing “because there are, for many people with dementia, behavioral and other approaches to provide this care more effectively and safely.”

In Connecticut, health care groups have formed a coalition — coordinated by Qualidigm, a Medicare quality-improvement organization — to improve dementia care and reduce antipsychotic use. The group is working to educate providers about the risks of using antipsychotics and the benefits of alternative, personalized interventions for dementia patients.

Ann Spenard, vice president of program operations for Qualidigm, said the state’s nursing homes are “heading in the right direction…

“Our focus is, and will continue to be, helping nursing homes to understand what drives behaviors and developing detailed care plans to help prevent or reduce the use of antipsychotic medications,” she said.

Connecticut’s rate of antipsychotic use is the second highest in New England, just after Massachusetts, the new data show. All other New England states saw higher declines than Connecticut over the last 21 months, including Maine, which cut its rate by 31.9 percent, and Rhode Island, where the rate dropped by 29.7 percent.

But nationally, some states, including Nebraska and Illinois, have seen only single-digit percentage declines.

Overall, the prevalence of antipsychotic use among long-stay nursing home residents is now 19.8 percent – down from 23.8 percent in 2011.

CMS officials said that while their focus is on antipsychotic medications, they also are reviewing prescribing rates of sedatives and anxiolytics, to make sure nursing homes do not just replace antipsychotics with other sedating drugs.


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