Nursing homes with high antipsychotic prescribing rates more likely to dispense drugs to residents who don’t need them

A new Institute for Clinical Evaluative Sciences (ICES) study shows that residents of Ontario nursing homes with high antipsychotic prescribing rates are about three times more likely than those in facilities with low prescribing rates to be dispensed an antipsychotic, regardless of whether they have an obvious need identified.

“The use of antipsychotic therapy in elderly nursing home residents should generally be reserved for situations where the benefits outweigh the risks, such as to manage psychoses and for situations where the behavioural problems pose a risk to the resident or others,” said Dr. Paula Rochon, ICES senior scientist and lead author of the study.

“However, there is some concern regarding the inappropriate and widespread prescribing of antipsychotic therapy in many nursing homes.”

To explore variation in the use of antipsychotics across Ontario nursing homes, and whether prescribing decisions are based on medical need, investigators tracked 47,322 residents of 485 provincially-regulated nursing homes in December 2003. Facilities were classified into groups according to their average antipsychotic prescribing rates. Residents were grouped into those with a potential clinical indication for antipsychotics (psychoses with or without dementia and dementia without psychoses) or no identified clinical need for antipsychotic therapy (without psychoses or dementia).

The results showed that:

• A total of 15,317 (32%) residents were dispensed an antipsychotic.
• The average rate of antipsychotic prescribing by home ranged from 21% in groups of facilities with the lowest average prescribing rates to 44% in groups of facilities with the highest average prescribing rates.
• Relative to individuals residing in nursing homes with the lowest average prescribing rates, those residing in facilities with the highest rates were three times more likely to be dispensed antipsychotics.
• This three-fold higher rate was seen within each clinical indication group, whether there was a potential clinical indication for the medications or not.

“Given the serious adverse events associated with the use of antipsychotic therapy, such as the risk of falls, hip fracture, parkinsonism, and death, non-drug approaches should always be explored first to manage agitated behaviour in nursing home residents,” said Dr. Rochon, who is also a senior scientist and geriatrician with Baycrest Geriatric Healthcare System.

“As such, these results provide an opportunity for nursing homes to reflect on their prescribing practices and to determine whether they can be improved.”

The study, “Variation in nursing home antipsychotic prescribing rates”, is in the April 9, 2007 issue of the Archives of Internal Medicine.

Author affiliations: ICES (Drs. Rochon, Stukel, Bronskill, Wodchis, and Anderson, Ms. Gomes, Ms. Sykora, Mr. Hillmer, and Mr. Kopp); Kunin-Lunenfeld Applied Research Unit, Baycrest (Dr. Rochon); Department of Medicine (Dr. Rochon), Health Policy, Management and Evaluation (Drs. Rochon and Stukel), University of Toronto.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• Julie Dowdie
• Media Relations Officer, ICES
• (416) 480-4780 or cell (416) 432-8143