CMS Strategies To Reduce Antipsychotic Drug Use In Nursing Home Patients With Dementia Show Some Progress

Area of Science:

• Gerontology
• Health Services Research
• Pharmacology

Background:

• Nursing homes frequently overprescribe antipsychotic medications, especially for behavioral symptoms of dementia.
• The Centers for Medicare and Medicaid Services implemented three strategies between 2012 and 2013 to curb this trend.

Purpose of the Study:

• To evaluate the impact of CMS strategies on antipsychotic medication use and related deficiencies in nursing homes.
• To assess the association between these strategies and the prevalence of antipsychotic prescribing.

Main Methods:

• Analysis of 86,163 state recertification surveys from 15,055 nursing homes (January 2009–March 2015).
• Examined changes in citations for unnecessary drug use and antipsychotic prevalence following each CMS strategy implementation.

Main Results:

• Strategies were linked to increased citations for unnecessary drug use only after the third strategy revision.
• Each strategy showed a modest but significant reduction in overall antipsychotic prevalence.
• Initial reductions were more pronounced in states with historically higher antipsychotic use.

Conclusions:

• CMS strategies contributed to a decline in antipsychotic prescribing, but enforcement consistency is key.
• Further monitoring of antipsychotic and other psychoactive medication use is necessary to sustain reductions.