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  • Posted April 26, 2024

Medicare Warnings Stop Nursing Homes From Overusing Antipsychotic Meds

Warning letters sent by Medicare officials can prompt a decline in antipsychotic prescriptions for seniors with dementia, a new study finds.

Letters sent to heavy prescribers of quetiapine (Seroquel), the most popular antipsychotic in the United States, led to a significant decline in drugs handed out to seniors, researchers reported April 25 in the journal JAMA Network Open.

“People with dementia living in nursing homes and in the community were prescribed less and we did not detect negative health impacts for these groups,” said lead study author Michelle Harnisch, a research student at the London School of Economics in the U.K.

Antipsychotics like quetiapine are often used in dementia care to manage behavioral symptoms like anxiety, agitation and delusions or hallucinations.

About one in every seven nursing home residents has been prescribed an antipsychotic, researchers said in background notes.

However, the drugs come with well-known health risks that have started raising concerns.

Dementia patients taking antipsychotics have an increased risk of a wide range of potentially fatal conditions, including a more than doubled risk of pneumonia, found a study published on April 17 in the BMJ.

The drugs were also associated with a 72% increased risk of kidney injury, a 62% increased risk of blood clots, a 61% increased risk of stroke, a 43% increased risk of bone fractures, a 28% increased risk of heart attack and a 27% increased risk of heart failure, the study found.

The U.S. Centers for Medicare and Medicaid Services is currently investigating the overuse of antipsychotic drugs in nursing homes.

This new study sought to evaluate the effectiveness of a clinical trial in which Medicare sent warning letters to health providers who frequently prescribed quetiapine.

Letters were sent to 5,055 doctors, who were providing the drug to almost 85,000 nursing home patients and more than 261,000 patients living in the community.

After the letters went out, there was a 7% reduction in quetiapine prescriptions for nursing home patients and a 15% reduction in prescriptions to patients living in the community.

The researchers also found that the patients did not suffer as a result of cutting back prescriptions for these meds.

In fact, there were signs of improved mental health among the patients, and the risk of death for patients living out in the community fell slightly.

“These results show that this intervention and others like it could be leveraged to make prescribing safer and improve dementia care,” researcher Adam Sacarny, an assistant professor of health policy and management at Columbia University, said in a university news release. “Similar interventions could also be adapted to other contexts to promote high-quality care.”

More information

The Alzheimer's Society has more on antipsychotics and dementia.

SOURCE: Columbia University, news release, April 25, 2024

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