title: Assessing approaches and barriers to reduce antipsychotic drug use in Florida nursing homes.
abstract: OBJECTIVE
  Antipsychotic medications have been federally regulated since 1987, yet research suggests they continue to be used inappropriately to alleviate behavioral symptoms associated with dementia. In 2012, the Centers of Medicare and Medicaid launched a new initiative to reduce antipsychotic medication in nursing homes by 15% nationally. The aim of this study was to examine qualitative data to explore strategies that have been implemented, to assess which strategies are evidence-based, and to make recommendations to improve upon practices to reduce antipsychotic medication use.
  
  
  METHODS
  A convenience sample of 276 nursing home professional staff members were surveyed about these topics using open-ended questions.
  
  
  RESULTS
  Theme-based content analysis yielded three main themes. The themes related to changes in practice included the following: (1) increased review of resident behavior and antipsychotic medication regimens; (2) reduction in antipsychotic medications or dosage; and (3) increased use of nonpharmacological interventions. The main themes relevant to needed assistance included the following: (1) education; (2) clinical support; and (3) increased financial resources and reimbursement.
  
  
  CONCLUSIONS
  Overall findings indicate that the majority of facilities are actively responding to the initiative, but challenges remain in education, finding mental health support, and in reimbursement.
authors.affiliation: School of Aging Studies, University of South Florida, Tampa, Florida; Florida Policy Exchange Center on Aging, University of South Florida, Tampa, Florida.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Ellis
authors.forename: Victor
authors.initials: V
authors.lastname: Molinari
authors.forename: Debra
authors.initials: D
authors.lastname: Dobbs
authors.forename: Kelly
authors.initials: K
authors.lastname: Smith
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hyer
mesh_terms: D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003704:Dementia / Q000188:drug therapy*; D005431:Florida; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D057970:Inappropriate Prescribing; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000191:economics / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009735:Nursing Homes / Q000458:organization & administration*; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D014150:Antipsychotic Agents
keywords: antipsychotic medications; nursing homes; qualitative methods; survey