Recent trends in antipsychotic use in US longterm care facilities

Introduction. In May 2011, a US Federal government investigation found high and inappropriate levels of atypical antipsychotic prescribing to elderly nursing home patients, which prompted widespread media attention and a host of national, state and local initiatives to reduce prescribing. Objective: This study determined whether recent trends in atypical antipsychotic prescribing in US long-term care (LTC) facilities have changed, relative to historical trends. METHODS. We used 2009-2012 prescription drug dispensing data from a large LTC pharmacy that serves 48 US states. Monthly prevalence of antipsychotic use was calculated as percentage of LTC patients in each month receiving 1 or more antipsychotic prescriptions. We plotted the prevalence estimates against a timeline of national LTC antipsychotic reduction initiatives. We used segmented times series models to compare changes in the levels and slopes of antipsychotic use before and after nationwide publicity and initiatives. RESULTS. We identified a total sample of 3.2 million unique LTC individuals. From October 2009 to August 2011, the monthly prevalence of antipsychotic prescribing in US LTC facilities persisted at a steady rate of 30.1% [range: 29.9-30.5]. Beginning in September 2011, atypical antipsychotic prescribing decreased significantly by .2 percentage points per month to 27.8% in December 2012. Comments. Antipsychotic prescribing in US LTC facilities has decreased significantly relative to historical trends following nationwide publicity and initiatives.