A study conducted at Columbia University Mailman School of Public Health has found that warning letters from Medicare can effectively reduce the prescribing of antipsychotic medications to older adults with dementia. The researchers analyzed data from hundreds of thousands of patients and found a significant and lasting reduction in prescribing after the letters were sent out. However, there were no adverse effects on patient health as a result of the intervention. The study was a collaborative effort with researchers from the London School of Economics, Harvard T.H. Chan School of Public Health, and Johns Hopkins University.
The trial focused on high prescribers of quetiapine, the most popular antipsychotic medication in the U.S., and targeted older adults with dementia who were being treated by these prescribers. Previous studies on reducing prescribing in dementia care have been limited in scope, with small trials or observational analyses providing inadequate evidence. The results of this study showed a reduction in prescribing of quetiapine to both nursing home residents and community-dwelling patients with dementia, without any negative impacts on their health.
Antipsychotic medications are commonly used in dementia care to address behavioral symptoms, despite the known risks associated with these drugs. These risks include weight gain, cognitive decline, falls, and even death. In response to these risks, physician specialty societies, government regulators, and policymakers have been working to reduce the prescribing of antipsychotics to people with dementia. The warning letter intervention studied in this research proved to be an effective and safe method to achieve this goal.
The study utilized Medicare data to link physicians who received the warning letters to their patients with dementia, totaling over 84,000 nursing home patients and 261,000 patients living in the community. The intervention resulted in a 7 percent reduction in quetiapine use among nursing home patients and a 15 percent reduction among community-dwelling patients. Despite the decrease in prescribing, there were no adverse effects on various health outcomes such as cognitive function, behavioral symptoms, depression, or metabolic outcomes like diabetes. In fact, there were indications of improved mental health outcomes and a slight decrease in the risk of death for community-based patients.
This research builds on the findings of a previous study by the same team, which demonstrated that the warning letters successfully reduced prescribing of antipsychotics. However, the previous study had a smaller patient sample and limited examination of health outcomes. The new study expands on these findings by evaluating key health indicators for dementia care and including a larger sample of patients with dementia. The researchers believe that interventions like the warning letters could be valuable tools in promoting high-quality care and improving patient outcomes in various healthcare settings.
The study was supported by the National Institute on Aging and the findings have implications for dementia care and prescribing practices in older adults. By demonstrating the effectiveness of a low-cost intervention such as warning letters in reducing potentially harmful medication use, this research highlights the importance of safe prescribing practices and the potential for targeted interventions to improve the quality of care for patients with dementia.
