A recent study at Columbia University Mailman School of Public Health suggests that warning letters from Medicare can effectively reduce the prescribing of a potent yet risky antipsychotic. Using Medicare data, researchers observed a significant and long-lasting decrease in prescribing among older adults with dementia, without any negative impact on patient health.
A recent study has revealed that simple and inexpensive letter interventions can effectively reduce the prescribing of antipsychotic medications to older adults with dementia. The study, which was published in JAMA Network Open, showed that this intervention led to a significant and long-lasting decrease in prescribing without any negative impact on patient health. Adam Sacarny, an assistant professor of Health Policy and Management at Columbia Mailman School, along with researchers from the London School of Economics, Harvard T.H. Chan School of Public Health, and Johns Hopkins University, conducted the study.Medicare sent warning letters to high prescribers of quetiapine, the most popular antipsychotic in the U.S. This drug is often prescribed to people with dementia, but can cause numerous harms in this group. Researchers studied hundreds of thousands of older adults with dementia who were treated by the prescribers in the trial. Previous studies on reducing prescribing in dementia care were small or observational, with limited evidence from large-scale randomized studies.
The results were startling. “People with dementia living in nursing homes and in the community were pre rnrnMichelle Harnisch, a research student at the London School of Economics and the first author of the study, stated that they found no negative health impacts for those prescribed less medication.
The study’s findings are significant because antipsychotics, like quetiapine, are commonly used in dementia care to manage behavioral symptoms. Approximately 1 in 7 nursing home residents receive antipsychotic medication every quarter. However, these drugs come with various well-known risks, including weight gain, cognitive decline, falls, and even death. As a result, physician specialty societies, government regulators, and policymakers have been working to reduce the prescribing of these medications.The study aimed to determine if sending warning letters to physicians would decrease the prescribing of antipsychotic medications to patients with dementia. The researchers used administrative data from Medicare to connect 5,055 physicians from the original trial to their patients’ Medicare records. They examined 84,881 patients in nursing homes and 261,288 patients living in the community.
The results showed that the intervention led to a 7 percent decrease in quetiapine use among nursing home patients and a 15 percent decrease among patients living in the community. Additionally, the researchers found no negative effects on various health outcomes, such as cognitive function, behavioral symptoms, depression, or mortality.The study found that warning letters reduced the risk of adverse health outcomes such as diabetes and improved mental health outcomes for patients living in the community. The research builds on a previous study that showed a decrease in prescribing due to the letters, but this new study expands the scope to include a larger sample of patients and a more comprehensive set of health indicators for dementia care.The outcomes indicate that this approach, as well as similar ones, could be utilized to enhance the safety of prescribing and enhance dementia care, Sacarny remarked “Comparable approaches could also be modified for other settings to support top-notch care” .
