TN nursing homes reduce antipsychotic drug use

Still above national average

Aug. 15, 2013

Vincent Davis, director of the state Office of Health Care Facilities, said the reduction was significant and 'a testament to the collaborative work of many stakeholders.' / Larry McCormack / The Tennessean

Written by

Walter F. Roche Jr.

The Tennessean

Tennessee nursing homes still use more antipsychotic drugs on their patients than the national average, but new data shows the state ranked fifth nationwide in lowering that rate over a two-year period.

Data released recently by the Centers for Medicare and Medicaid Services show the percentage of long-term nursing home patients in Tennessee being treated with powerful antipsychotic drugs dropped 16.46 percent from the first quarter of 2011 to the first quarter of 2013.

That still leaves the Volunteer State with the third-highest rate in the nation. The data is collected on patients whose diagnosis indicates they are not candidates for antipsychotic drugs.

State officials attribute the reduction in Tennessee from 29.27 percent of nursing home patients in the first quarter of 2011 to 25.02 percent in the first quarter of this year to a series of training workshops for nursing home staffers conducted last year with a federal grant.

The sessions, including methods to deal with patients’ behavior without medication, were held across the state by the Eden Alternative, a New York state nonprofit. The project was funded with a $370,000 grant from CMS.

Federal health officials have been waging a national campaign to cut antipsychotic drug use on patients with dementia because of the potential for adverse effects, including death. The drugs are approved by the Food and Drug Administration for use on patients suffering from schizophrenia, bipolar disorder, Huntington’s Disease or Tourette’s Syndrome.

The new data show that nursing homes nationwide still have a long way to go before achieving the initial federal goal of 15 percent.

Despite Tennessee’s significant improvement, its 25.02 percent rate is still among the worst in the nation. Only Louisiana and Arkansas have higher rates. The national average in the first quarter of 2013 was 21.71 percent.

But even ranking 48th was an improvement. At the beginning of the study period only one state, Louisiana, had a worse rate, 30.9 percent, than Tennessee.

Hawaii had the best rate with 10.98 percent, according to the new data. Alaska was next with a rate of 12.54 percent, followed by Michigan at 14.9 percent.

Vincent Davis, director of the state Office of Health Care Facilities, said the reduction was significant and “a testament to the collaborative work of many stakeholders.”

“The numbers are really great,” said Dr. G Allen Power, an Eden Alternative mentor who led four sessions in Tennessee. “It’s really nice to see that improvement.”

Under federal regulations, a black box label is required on antipsychotic drugs noting the increased risk for dementia patients.

“Elderly patients with dementia related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo,” the approved label states.

Experts estimate that 65 to 70 percent of nursing home residents suffer from varying degrees of dementia.

Among area homes, the percentage of long-term residents getting antipsychotic drugs range from 10 percent at the Health Center at Richland Place to 46.1 percent at Crestview Health and Rehabilitation Center, according to CMS.