Antipsychotic choices in nursing homes partly influenced by nursing home’s prescribing culture
Elderly Health/Long-Term Care
Between one-fifth and one-third of all nursing home patients receive antipsychotic medications. Their use continues to remain popular despite serious safety concerns. Today, nursing homes can select from older, conventional agents to newer, atypical ones. A new study reveals that the majority of nursing homes favor treating patients with atypical antipsychotics. Yet, patients and facility characteristics contribute partially to the medications selected.
Using a variety of data sources, including Medicaid and Medicare data, the researchers identified 65,618 patients 65 years or older residing in nursing homes in 45 States. All had started treatment with an antipsychotic after their admission between 2001 and 2005. Nearly half of the nursing homes studied (45 percent) never prescribed a conventional antipsychotic medication. In fact, 91.2 percent of patients started treatment with an atypical medication. Of the 8.8 percent of patients treated with a conventional medication, the most frequently prescribed drugs were haloperidol (86 percent) and chlorpromazine (8 percent).
Among atypical agents, the most popular choices were risperidone (41 percent) followed by olanzapine (32 percent) and quetiapine (23 percent). Nursing homes that favored conventional agents tended to have a larger proportion of less educated patients. They also had a greater proportion of patients with congestive heart failure and those with a history of hypnotic medication use. Facilities preferring atypical agents had more white patients and more patients with dementia or depression. Nursing homes prescribing conventional agents tended to be hospital-based, while those prescribing atypical agents tended to be larger, urban-based facilities with special Alzheimer care units and a team-based approach to care.
Individually, patient characteristics accounted for 36 percent of the between-nursing home variation in prescribing (atypical vs. conventional antipsychotic), facility characteristics for 23 percent, and nursing home prescribing tendency (prescribing 'culture') for 81 percent. The study was supported in part by the Agency for Healthcare Research and Quality (HS17918).
See "Variation in antipsychotic treatment choice across US nursing homes," by Krista F. Huybrechts, MS, PhD, Kenneth J. Rothman, DrPH, M. Alan Brookhart, PhD, and others in the February 2012 Journal of Clinical Psychopharmacology 32(1), pp. 11-17.