Nursing homes underreport antipsychotic prescribing

Area of Science:

• Gerontology
• Health Services Research
• Pharmacoepidemiology

Background:

• Antipsychotic medication use in nursing homes is a significant concern.
• Medicare implemented a campaign to reduce antipsychotic prescribing in long-stay nursing home residents.
• Accurate data on antipsychotic prescribing is crucial for evaluating public health initiatives.

Purpose of the Study:

• To assess the accuracy of nursing home self-reported antipsychotic prescribing data.
• To compare self-reported data with claims-based prescribing before and after a Medicare campaign.
• To identify factors associated with discrepancies in reporting.

Main Methods:

• A quasi-experimental study design was employed.
• Data from a nationwide sample of 11,912 nursing facilities (2011-2013) were analyzed.
• Prescribing trends were compared between self-reports, Medicare Part D claims, and pharmacy dispensing data for 586,281 long-stay residents.

Main Results:

• Nursing homes consistently underreported antipsychotic prescribing by approximately 1% quarterly compared to Medicare Part D claims.
• The underreporting gap widened by an additional 0.5% after the Medicare campaign.
• Residents with dementia, Alzheimer's disease, or bipolar disorder were at higher risk for underreported prescribing. For-profit facilities and those in the US South showed increased underreporting post-campaign.

Conclusions:

• Nursing home self-reported data may significantly underestimate antipsychotic prescribing rates, potentially misrepresenting up to 6,000 residents per quarter.
• Discrepancies highlight potential biases in self-reported data, impacting the evaluation of interventions.
• High agreement (99.7%) was found between claims and dispensing data, validating claims as a reliable source.