MDS Alert

Published on Wed Feb 20, 2013 PDF

Residents in central south states more likely to get antipsychotic prescriptions.

Overall about 22% of nursing home residents were prescribed antipsychotic drugs in 2009-2010, but residents in the south central states were more likely to receive these drugs than those in other geographic regions, according to a new study published in the February 6, 2013, issue of the Journal of the American Medical Association (JAMA).

About 28% of residents in nursing homes in Texas, Louisiana, Mississippi, Arkansas, Missouri, Kansas, Tennessee, Kentucky, Georgia and Illinois were prescribed antipsychotic drugs, whereas only approximately 17-20% of residents in western states such as Washington, Oregon, California, Nevada, and Arizona got antipsychotic drugs.

The authors of the study, led by Becky A. Briesacher, PhD, of the University of Massachusetts Medical School in Worcester, Mass., noted that the reasons for the findings were unclear. "Geographic variation suggests the absence of an evidence-based approach to the use of these medications in NH," they stated in the JAMA Research Letter Antipsychotic Use Among Nursing Home Residents.

The study analyzed prescription dispensing data from Omnicare Inc., a large, long-term care pharmacy that serves 48 states and half of all nursing home residents in the United States. Of the overall sample of about 1.4 million nursing home residents, 22% received one or more prescriptions of antipsychotics.

The most prescribed antipsychotic drug was quetiapine fumarate, which was prescribed to about 1.4 million residents, followed by risperidone, prescribed to about 1.1 million residents. About 570,000 residents were prescribed olanzapine; 402,077 haloperidol, 347,900 aripiprazole; 232,125, clozapine; 138,881 ziprasidone; 65,159 chlorpromazine; and 54,867 fluphenazine.

Among the 186,076 residents receiving antipsychotics and observed for 90 days, about 7.5% received only 1 prescription for antipsychotics while the median number was 10 prescriptions. The median duration of antipsychotic therapy during the 90-day observation period ranged from 30 days to 77 days. The authors noted that they were unable to assess appropriate versus inappropriate prescribing.

Watch out: CMS is closely monitoring the use of antipsychotic medications in nursing homes as part of its quality initiative. For more information, see the June 2012 issue of MDS Alert.

Editor’s note: The full text of the Research Letter on Antipsychotic Use Among Nursing Home Residents can be obtained at: jama.jamanetwork.com/article.aspx?articleID=1568246. The corresponding author of the study can be contacted at becky.briesacher@umassmed.edu.