The use of antipsychotic medications in U.S. nursing homes is high—nearly 30 percent of the 1.6 million nursing home residents in this country are prescribed medications such as those used for schizophrenia and bipolar disorder. In an effort to explore how to improve prescribing practices and reduce the use of antipsychotics in the nursing home setting, the Agency for Healthcare Research and Quality (AHRQ) has awarded a $1.5 million grant to UMass Medical School.
“While antipsychotics have a value and serve an important purpose for patients who have been diagnosed with specific mental illnesses, they can pose a significant risk among the elderly when they are used inappropriately,” said Jerry H. Gurwitz, MD, the Dr. John Meyers Professor of Primary Care Medicine, professor of medicine and family medicine & community health and chief of the Division of Geriatric Medicine at the UMass Memorial Medical Center. Dr. Gurwitz is principal investigator of the AHRQ grant with Becky A. Briesacher, PhD, associate professor of medicine, and Jennifer Tjia, MD, MSCE, assistant professor of medicine.
Through this grant, Gurwitz, Dr. Briesacher, Dr. Tjia and colleagues at the Meyers Primary Care Institute and the Division of Geriatric Medicine—who have published numerous studies on geriatric care and are widely recognized as experts in medication errors and adverse drug events among nursing home patients—will extend the reach and impact of guidelines for care that were developed from prior research and analysis of clinical practice.
The team will work with nursing home administrators, prescribers, consultant pharmacists and nursing staff. They will first conduct a needs assessment to discern whether barriers exist in the nursing home setting that prevent the use of the best available evidence to guide use of these medications. They will also identify factors that may influence the use of antipsychotics, and create a toolkit to guide when to prescribe antipsychotics in the nursing home setting.
“The nursing home population is a significantly challenging one to care for,” said Tjia, noting that 40 to 60 percent of residents have dementia. “There is mounting evidence that antipsychotics, though widely used to manage behavioral disturbances and agitation associated with dementia, are only modestly effective and pose serious safety concerns for these residents. By applying evidence-based guidelines, we’re hoping to help nursing homes reduce the risks associated with the use of antipsychotic medications.”
The UMMS study will be conducted in collaboration with Qualidigm, a Connecticut-based quality improvement organization, and Omnicare, the nation’s largest long-term care pharmacy. Other members of the research team include UMMS faculty Terry Field, ScD, Kathleen Mazor, EdD, and Leslie Harrold, MD, MPH, all associate professors of medicine; and Arlene Ash, PhD, professor and a division chief in the Department of Quantitative Health Sciences; along with Massachusetts College of Pharmacy and Health Sciences faculty Jennifer Donovan, PharmD, associate professor of pharmacy practice, and Abir Kanaan, PharmD, assistant professor of pharmacy practice.