When Medicare sent warning letters urging doctors to lower antipsychotic prescriptions, it worked, a report published Thursday in JAMA Network Open found.
During the experiment from 2015 to 2018, Medicare sent warning letters to frequent prescribers of the antipsychotic drug quetiapine, the most popular antipsychotic medicine prescribed in the United States. The medications are often used in dementia care to address behavioral symptoms. Risks include weight gain, cognitive decline, falls and death, which is why efforts are underway to reduce prescribing of these medications to people with dementia.
For the study, Medicare sent letters to 5,055 primary care doctors who were the top prescribers of the drug; 2,528 got a placebo letter and 2,527 were randomized to receive three warning letters letting them know their quetiapine prescribing was high and was under review by Medicare. The team analyzed data from 84,881 patients in nursing homes and 261,288 patients living in the community who were all reached by doctors who received the letters. All of the patients used Medicare.
The intervention reduced quetiapine use among nursing home residents by 7% and community-dwelling patients by 15%.
“Our study shows that low-cost letter interventions can safely reduce antipsychotic prescribing to patients with dementia,” Adam Sacarny, PhD, an author and assistant professor of Health Policy and Management at Columbia Mailman School, said in a statement.
“People with dementia living in nursing homes and in the community were prescribed less and we did not detect negative health impacts for these groups,” said Michelle Harnisch, research student at the London School of Economics and first author of the study.
The team’s original study found that the letters reduced prescribing, but it was a smaller number of people studied and a limited set of outcomes. The new study, on the other hand, tested the efficacy of letters in more people and focused on more indicators of dementia care, specifically.
