The Obama administration has called for national action on antibiotics.

Instead of decreasing drug use, prescribers looking to treat behavioral issues among dementia patients merely may be shifting from antipsychotics to mood stabilizers.

That’s the finding of a new study of nursing homes published online first by JAMA this weekend in conjunction with the American Association for Geriatric Psychiatry Annual Meeting.

Researchers at the University of Michigan reviewed a five-year sample of about 637,000 fee-for-service Medicare beneficiaries in long-term care with Part D coverage, ending in January 2018.

Use of antipsychotics and psychotropics fell after the Centers for Medicare & Medicaid launched its National Partnership to Improve Dementia Care in Nursing Homes in 2012, but the researchers noted decreases had occurred previously and did not accelerate.

At the same time, however, mood stabilizers’ use increased by 2.5%. Stabilizers include antiepileptic medications, like sodium valproate and carbamazepine, often used to treat bipolar disorder.

“Rather than increasing the use of nonpharmacologic treatments, prescribers may have shifted prescribing from antipsychotics to mood stabilizers, even though mood stabilizers have less evidence of benefit for the behavioral and psychological symptoms of dementia,” reported the researchers, led by Donovan T. Maust, M.D., with the Program for Positive Aging in the Department of Psychiatry at Michigan. “Measuring use of antipsychotics alone may be an inadequate proxy for quality of care and may have contributed to a shift in prescribing to alternative medications with a poorer risk-benefit balance.”

Nonpharmacologic interventions to address behavior are recommended by numerous guidelines and medical organizations, but the doctors involved in the study said the treatment “mainstay” remains the off-label use of psychotropic medications.

In light of the apparent drug substitution, the team called on CMS to incorporate more comprehensive measures to capture all psychotropic use and consider how the agency could incentivize person-centered dementia care practices.