Internists, family medicine physicians, psychiatrists and neurologists wrote more than 80% of the prescriptions for antipsychotics for older adults with dementia in 2012, according to a report calling for expanded federal efforts to curb use of the drugs.
Though several initiatives have addressed overuse of the medications among nursing home patients who do not have a diagnosis of psychosis, no actions have specifically been directed to other settings, according to a Government Accountability Office report released this week.
About 14% of Medicare Part D enrollees with dementia who were prescribed an antipsychotic in 2012 lived outside of a nursing home. About one-third of older adults with dementia given the drugs spent more than 100 days in a nursing home that year.
“Antipsychotic drugs are often initiated in hospital settings and carried over when older adults are admitted to a nursing home,” the report said.
The GAO found that 36% of antipsychotic prescriptions in elderly patients with dementia came from internists, 30% from family physicians and 16% from psychiatrists or neurologists. Those prescriptions accounted for $298 million in Medicare Part D plan payments.
Additional efforts are needed to curb the practice among the 1.2 million adult Medicare Part D patients with dementia not in nursing homes, the GAO said.
The Medicare prescription drug program paid roughly $363 million in 2012 for antipsychotic drugs in elderly patients with dementia. The drugs are often prescribed off-label to manage challenging behavioral symptoms associated with dementia, such as agitation, aggression and mood changes. They are mainly FDA-approved for the treatment of schizophrenia. Use in patients with dementia has been linked to adverse events, such as falls and increased risk of death.
For more than two years, the National Partnership to Improve Dementia Care in Nursing Homes, a CMS public-private partnership on nursing home safety, has been setting national goals for nursing homes to reduce the rates of antipsychotic drug overuse. In February, the federal agency announced it had added two quality measures related to the appropriate use of antipsychotic medications to its five-star rating system for nursing homes.
The GAO recommends HHS expand this type of outreach to hospitals and assisted-living facilities.
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