Consequences of Reduced Antipsychotic Prescribing in Nursing Homes

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DESCRIPTION (provided by applicant): 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.