title: Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education.
abstract: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: W A
authors.initials: WA
authors.lastname: Ray
authors.forename: J A
authors.initials: JA
authors.lastname: Taylor
authors.forename: K G
authors.initials: KG
authors.lastname: Meador
authors.forename: M J
authors.initials: MJ
authors.lastname: Lichtenstein
authors.forename: M R
authors.initials: MR
authors.lastname: Griffin
authors.forename: R
authors.initials: R
authors.lastname: Fought
authors.forename: M L
authors.initials: ML
authors.lastname: Adams
authors.forename: D G
authors.initials: DG
authors.lastname: Blazer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy / Q000193:education*; D003704:Dementia / Q000188:drug therapy / Q000451:nursing*; D004363:Drug Utilization; D004496:Education, Continuing; D004502:Education, Medical, Continuing; D004509:Education, Nursing, Continuing; D005260:Female; D006707:Homes for the Aged / Q000592:standards*; D006801:Humans; D008297:Male; D009735:Nursing Homes / Q000592:standards*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D014481:United States
chemical_list: D011619:Psychotropic Drugs