Monday, March 03, 2008

Antipsychotics used to Knock Out Grandma and Grandpa

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Low Risk Patients - Heavy Drugs
State's Nursing Homes Might Be Overusing Antipsychotics

March 2, 2008

Connecticut's nursing homes dole out antipsychotic drugs to residents who do not have psychotic disorders at one of the highest rates in the country, raising questions about whether the medications are being used to subdue agitated patients because of a lack of staffing and attention to alternate treatments.

Federal data from the Centers for Medicare & Medicaid Services show that since 2005, Connecticut has consistently ranked in the top four states in the prevalence of antipsychotic drugs dispensed to nursing home residents who have no psychotic or related conditions. In the most recent quarterly report, through September 2007, only Louisiana had a higher prevalence rate than Connecticut, where more than 26 percent of residents who lacked an appropriate psychiatric diagnosis were prescribed antipsychotics.

Nationally, the prevalence rate is 19.8 percent, with several states, such as Florida, Pennsylvania and New Jersey, well below that average.

"This is not a good indicator" for Connecticut, said Charlene Harrington, an expert on nursing home quality and professor of sociology and nursing at the University of California-San Francisco. "One of the main factors [for a high medication rate] is not having enough staff. If patients are having behavioral problems, it's easier to give them a pill to keep them quiet" than to hire more staff. "It's cheaper. They'll sleep a lot."

Nursing-home staffing is now a focus of state lawmakers, who are weighing proposals that would update the state's minimum staffing standards to nationally recommended levels. The existing standards are more than 25 years old and rank among the least stringent in the country. The staffing proposals were prompted by a series in The Courant that detailed the troubled patient-care and financial history of one of the state's largest chains, Haven Healthcare, which filed for bankruptcy after the stories appeared.

Federal data from the past three years show that Connecticut has ranked highest or second-highest among states in the prevalence of antipsychotic use among "low-risk" nursing home residents, defined as those who do not exhibit cognitive impairment and behavioral problems. In the most recent reporting period, 23.3 percent of low-risk residents were receiving antipsychotics, compared with the national average of 16.5 percent.

Among "high-risk" residents who do exhibit those problems, Connecticut prescribes antipsychotics at the highest rate in the country — 55.2 percent, compared with the national average of 42.5 percent, according to data from the most recent reporting period.

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