Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education.

Objective: In the United States, 20% or more of nursing home residents receive antipsychoticdrugs, primarily for the behavioral manifestations of dementia. This high level of use of drugs with substantial toxicity has engendered a strong and persistent controversy and recently has led to explicit regulatory measures to curtail use (Omnibus Budget Reconciliation Act of 1987). We developed and tested a comprehensive program to reduce antipsychoticuse through education of physicians, nurses, and other nursing home staff. The primary elements of the program were instruction in use of behavioral techniques to manage behavior problems and encouragement of a trial of gradual antipsychoticwithdrawal. Design: In a nonrandomized controlled trial, the program was implemented (beginning in August 1990) in two rural Tennessee community nursing homes with elevated antipsychoticuse; two other comparable homes were selected as concurrent controls. Patients: Throughout the study 194 residents were in the education homes and 184 were in the control homes. Residents in both groups of homes had comparable demographic characteristics and functional status, and each group had a baseline rate of 29 days of antipsychoticuse per 100 days of nursing home residence. Main Outcome Measures: The primary end points were postintervention changes in administration of antipsychoticsand other psychotropic drugs, use of physical restraints, and frequency of behavior problems. Results: Days of antipsychoticuse decreased by 72% in the education homes vs 13% in the control homes ( P P Conclusions: The educational program led to a substantial reduction in antipsychoticuse with no increase in the frequency of behavior problems. This suggests that for many antipsychoticdrug users benefits may be marginal and that programs to reduce such drug use among the 250 000 US nursing home residents receiving these drugs should have high priority. (Arch Intern Med. 1993;153:713-721)