The Effects of Antipsychotic Quality Reporting on Antipsychotic and Psychoactive Medication Use

Abstract

Objective. The objective of this study is to examine how nursing homes changed their use of antipsychotic and other psychoactive medications in response to Nursing Home Compare's initiation of publicly reporting antipsychotic use in July 2012. Research Design and Subjects. The study includes all state recertification surveys (n = 40,415) for facilities six quarters prior and post the initiation of public reporting. Using a difference-in-difference framework, the change in use of antipsychotics and other psychoactive medications is compared for facilities subject to public reporting and facilities not subject to reporting. Principal Findings. The percentage of residents using antipsychotics, hypnotics, or any psychoactive medication is found to decline after public reporting. Facilities subject to reporting experienced an additional decline in antipsychotic use (À1.94 vs. À1.40 percentage points) but did not decline as much for hypnotics (À0.60 vs. À1.21 percentage points). Any psychoactive use did not vary with reporting status, and the use of antidepressants and anxiolytics did not change. Conclusion. Public reporting of an antipsychotic quality measure can be an effective policy tool for reducing the use of antipsychotic medications-though the effect many only exist in the short run.

Comparing Three Methods for Reducing Psychotropic Use in Older Demented Spanish Care Home Residents

“…An international human rights group has identified a moral imperative for national governments to address overuse of psychotropic medications in older nursing home residents with dementia . The United States has used public reporting of antipsychotic utilization to facilitate reductions in psychotropic prescribing rates, an effort that increased medication reviews, reduced medication use, and increased use of nonpharmacological interventions . Spanish regulators might consider requiring public reporting of psychotropic medication use in care homes, an effort that might encourage uptake of the types of tools we studied, reduce overuse of such medications in a vulnerable population, and improve the quality and dignity of care provided to older Spanish citizens who are living with dementia.…”

Antipsychotic Use in Dementia

“…In the United States, an antipsychotic indicator similar to the CIHI indicator is reported. [108][109][110] Unlike the CIHI indicator, the presence of delusions or hallucinations is not an exclusion criteria, whereas bipolar disorder is. 109 The US Centers for Medicare and Medicaid Services has been publicly reporting information on LTC quality indicators since 2002, although public reporting of antipsychotics began only in 2012.…”

A Review Exploring the Relationship Between Nursing Home Staffing and Antipsychotic Medication Use

“…Bowblis et al [ 40 ] found that deficiency citation rates for NHs during a prior state inspection have an impact on AP use in response to the citation. Another analysis of the public reporting of AP use demonstrated a decline in use once the facility was subjected to reporting [ 41 ]. The ACA’s NH quality provisions emphasize transparency through public reporting of staffing and expenses [ 42 ].…”