Skip to main content

Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education.

Publication ,  Journal Article
Ray, WA; Taylor, JA; Meador, KG; Lichtenstein, MJ; Griffin, MR; Fought, R; Adams, ML; Blazer, DG
Published in: Arch Intern Med
March 22, 1993

OBJECTIVE: In the United States, 20% or more of nursing home residents receive antipsychotic drugs, primarily for the behavioral manifestations of dementia. This high level of use of drugs with substantial toxicity has engendered a strong and persistent controversy and recently has led to explicit regulatory measures to curtail use (Omnibus Budget Reconciliation Act of 1987). We developed and tested a comprehensive program to reduce antipsychotic use through education of physicians, nurses, and other nursing home staff. The primary elements of the program were instruction in use of behavioral techniques to manage behavior problems and encouragement of a trial of gradual antipsychotic withdrawal. DESIGN: In a nonrandomized controlled trial, the program was implemented (beginning in August 1990) in two rural Tennessee community nursing homes with elevated antipsychotic use; two other comparable homes were selected as concurrent controls. PATIENTS: Throughout the study 194 residents were in the education homes and 184 were in the control homes. Residents in both groups of homes had comparable demographic characteristics and functional status, and each group had a baseline rate of 29 days of antipsychotic use per 100 days of nursing home residence. MAIN OUTCOME MEASURES: The primary end points were postintervention changes in administration of antipsychotics and other psychotropic drugs, use of physical restraints, and frequency of behavior problems. RESULTS: Days of antipsychotic use decreased by 72% in the education homes vs 13% in the control homes (P < .001). No significant changes were noted in the use of other psychotropic drugs in either group. Days of physical restraint use decreased 36% in the education homes vs 5% in the control homes (P < .001). Behavior problem frequency did not increase in either group, even among the 48% of baseline antipsychotic users in the education homes who had antipsychotic drug regimens discontinued for 3 or more months. CONCLUSIONS: The educational program led to a substantial reduction in antipsychotic use with no increase in the frequency of behavior problems. This suggests that for many antipsychotic drug users benefits may be marginal and that programs to reduce such drug use among the 250,000 US nursing home residents receiving these drugs should have high priority.

Duke Scholars

Published In

Arch Intern Med

ISSN

0003-9926

Publication Date

March 22, 1993

Volume

153

Issue

6

Start / End Page

713 / 721

Location

United States

Related Subject Headings

  • United States
  • Psychotropic Drugs
  • Nursing Homes
  • Male
  • Humans
  • Homes for the Aged
  • General & Internal Medicine
  • Female
  • Education, Nursing, Continuing
  • Education, Medical, Continuing
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Ray, W. A., Taylor, J. A., Meador, K. G., Lichtenstein, M. J., Griffin, M. R., Fought, R., … Blazer, D. G. (1993). Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education. Arch Intern Med, 153(6), 713–721.
Ray, W. A., J. A. Taylor, K. G. Meador, M. J. Lichtenstein, M. R. Griffin, R. Fought, M. L. Adams, and D. G. Blazer. “Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education.Arch Intern Med 153, no. 6 (March 22, 1993): 713–21.
Ray WA, Taylor JA, Meador KG, Lichtenstein MJ, Griffin MR, Fought R, et al. Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education. Arch Intern Med. 1993 Mar 22;153(6):713–21.
Ray, W. A., et al. “Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education.Arch Intern Med, vol. 153, no. 6, Mar. 1993, pp. 713–21.
Ray WA, Taylor JA, Meador KG, Lichtenstein MJ, Griffin MR, Fought R, Adams ML, Blazer DG. Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education. Arch Intern Med. 1993 Mar 22;153(6):713–721.

Published In

Arch Intern Med

ISSN

0003-9926

Publication Date

March 22, 1993

Volume

153

Issue

6

Start / End Page

713 / 721

Location

United States

Related Subject Headings

  • United States
  • Psychotropic Drugs
  • Nursing Homes
  • Male
  • Humans
  • Homes for the Aged
  • General & Internal Medicine
  • Female
  • Education, Nursing, Continuing
  • Education, Medical, Continuing