Impact of national partnership to improve dementia care on antipsychotic use duration for dementia residents in nursing homes

TL;DR

This study examines how federal policies affected the duration of antipsychotic use in nursing home residents with dementia.

Contribution

The study is the first to evaluate the impact of federal policies on the duration of antipsychotic treatment in nursing home residents.

Findings

Treatment duration within six months declined slightly after policy implementation.

Residents who started antipsychotics after policy changes were more likely to discontinue within six months.

More than half of residents continued treatment beyond six months despite policy efforts.

Abstract

Federal policies have successfully targeted the prevalence of antipsychotic (AP) exposure in NHs, but the duration of treatment among nursing home (NH) residents has not been reported. We evaluated AP duration and discontinuation within six months in residents with dementia.

Retrospective cohort study of long-stay NH residents with dementia who newly initiated an AP medication. We evaluated changes in AP duration and discontinuation within six months relative to two federal initiatives: National Partnership to Improve Dementia Care (2012) and inclusion of AP use measures in the NH Star Ratings (2015). We accounted for resident and facility characteristics in a competing-risks analysis establishing the relationship between the two policy periods and AP outcomes.

There were 43 668 new episodes of AP initiation among 38 275 residents. The duration of treatment within six months declined from 125.9 days in the pre-Partnership period to 120.5 days and 120.6 days in the post-Partnership and post-Five Star periods, respectively. Those who initiated APs after the Partnership [adjusted hazard ratio (aHR) = 1.17; confidence interval, 1.10-1.24] and after the Five Star Rating change (aHR = 1.19; 95% CI, 1.07-1.32) policy periods were more likely to stop the medication within 6 months as compared to those who initiated during the prior period.

Federal policies designed to reduce AP prescribing in NH residents with dementia had a nominal impact on treatment duration within the first six months, with more than half continuing treatment beyond 6 months.

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