California long-term care providers have success in reducing antipsychotics use in nursing homes

December 13, 2013
Area(s) of Interest: Drug Prescribing/Dispensing Patient Care 

As the nation's population of older adults continues to expand, so does the opportunity to improve quality of care and quality of life for our elderly patients. Last year, the Centers for Medicare and Medicaid Services (CMS) launched a national initiative to improve the use of antipsychotic medications in nursing home residents.

The use of antipsychotic medications in nursing homes has been tied to the continued growth in the number of elderly patients with dementia, the need for interventions in patients with severe persistent behavioral symptoms and a lack of effective therapeutic or behavioral interventions. Opportunities for improvement in the use of these medications is focused on: providing residents and their designated representatives with accurate and complete information to make informed decisions; considering non-pharmacologic interventions along with risk and benefits associated with the medication prior to use; developing and implementing a complete and accurate care plan related to behavioral modifications and antipsychotic use; and provision of quality consultant pharmacist services.

Although the use of antipsychotic medications in California nursing homes remained relatively unchanged from 2009 to 2011 and was lower than the national average, a unique partnership of nursing home providers, advocates, physicians, government agencies and others have since been working together with CMS and the California Department of Public Health (CDPH) to embrace the national initiative and present solutions.

In California, the results of the initiative have been positive. CDPH recently announced that the combined efforts of California stakeholders and CMS/CDPH enforcement activities resulted in an overall 8.5 percent reduction in nursing home antipsychotic utilization in 2012 (for long stay residents). Significant additional reductions are anticipated by the end of 2013.

Members of the California coalition—California Partnership to Improve Dementia Care and Antipsychotic Medication Reduction in Nursing Homes Collaborative—include CDPH; CMS; California Medical Association; California Medical, Pharmacy and Nursing Boards; Alzheimer's Association; California Advocates for Nursing Home Reform; California Association of Health Facilities; California Association of Long-Term Care Medicine; California Hospital Association; California Long-Term Care Ombudsman Association; California Office of the State Long-Term Care Ombudsman; Health Services Advisory Group; and Occupational Therapy Association.

The coalition invites interested parties to attend a symposium designed to teach non-pharmacologic interventions for the treatment of people with dementia. The one day symposium, "Relationships: The New Medicine for Dementia," will be February 6, 2014, Santa Clara. Registration is $40 and free continuing education units are available. Click here for more information or to register.

The Coalition also encourages interested parties to take advantage of a FREE, five-hour course on dementia and behavioral manifestations being offered by the American Medical Directors Association (AMDA), with support from a grant from the Agency for Healthcare Research and Quality.

Additional information on the California Partnership to Improve Dementia Care and Antipsychotic Medication Reduction in Nursing Homes Collaborative can be found at www.cdph.ca.gov/programs/LnC/Pages/AntipsychoticCollab.aspx and www.calculturechange.org.


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