Unexplained Variation Across US Nursing Homes in Antipsychotic Prescribing Rates

Antipsychotic prescribing patterns vary by nursing home and appear to be more a matter of facility prescribing culture than residents’ clinical status.

More than 29 percent of U.S. nursing home residents received at least one antipsychotic drug in 2006; some 32 percent of whom had no clinical need for those drugs. If much of that prescribing was due to facility-level factors, then residents who entered nursing homes with high facility-prescribing rates would be more likely to receive antipsychotic medications that those who entered nursing homes with lower prescribing rates.

The researchers categorized nursing homes into quintiles by prescribing rates. Comparing lowest prescribing rates (Q1) to highest prescribing rates (Q5), they found that:

  • Residents newly admitted to Q5 nursing homes were 1.37 times more likely to receive antipsychotic medication that those admitted to Q1 nursing homes.
  • Q5 nursing homes were more likely to be located in the south and have fewer than 250 residents.
  • Q1 nursing home residents tended to be older, female and white.
  • More residents in Q5 nursing homes had moderate or severe behavioral problems and psychosis.
  • Q5 residents with dementia and no psychosis were more likely to be prescribed antipsychotics.

Given safety concerns about antipsychotic drugs, this study could inform future policies to target high-prescribing nursing homes and improve the quality of care for nursing home residents.