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Original research
Public reporting of antipsychotic prescribing in nursing homes: population-based interrupted time series analyses
  1. Noah M Ivers1,2,
  2. Monica Taljaard3,4,
  3. Vasily Giannakeas5,
  4. Catherine Reis1,
  5. Evelyn Williams6,
  6. Susan Bronskill7
  1. 1 Women’s College Research Institute and Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
  2. 2 Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  3. 3 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  4. 4 School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
  5. 5 Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
  6. 6 Division of Long Term Care, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
  7. 7 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  1. Correspondence to Dr Noah M Ivers, Women’s College Research Institute and Women’s College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, Toronto, ON M5S 1B2, Canada; noah.ivers{at}utoronto.ca

Abstract

Background Although sometimes appropriate, antipsychotic medications are associated with increased risk of significant adverse events. In 2014, a series of newspaper articles describing high prescribing rates in nursing homes in Ontario, Canada, garnered substantial interest. Subsequently, an online public reporting initiative with home-level data was launched. We examined the impact of these public reporting interventions on antipsychotic prescribing in nursing homes.

Methods Time series analysis of all nursing home residents in Ontario, Canada, between 1 October 2013 and 31 March 2016. The primary outcome was the proportion of residents prescribed antipsychotics each month. Balance measures were prescriptions for common alternative sedating agents (benzodiazepines and/or trazodone). We used segmented regression to assess the effects on prescription trends of the newspaper articles and the online home-level public reporting initiative.

Results We included 120 009 nursing home resident admissions across 636 nursing homes. Following the newspaper articles, the proportion of residents prescribed an antipsychotic decreased by 1.28% (95% CI 1.08% to 1.48%) and continued to decrease at a rate of 0.2% per month (95% CI 0.16% to 0.24%). The online public reporting initiative did not alter this trend. Over 3 years, there was a net absolute reduction in antipsychotic prescribing of 6.0% (95% CI 5.1% to 6.9%). Trends for benzodiazepine prescribing did not change as substantially during the period of observation. Trazodone use has been gradually increasing, but its use did not change abruptly at the time of the mass media report or the public reporting initiative.

Interpretation The rapid impact of mass media on prescribing suggests both an opportunity to use this approach to invoke change and a warning to ensure that such reporting occurs responsibly.

  • public reporting interventions
  • antipsychotic prescribing
  • nursing homes
  • interrupted time series

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjqs-2018-007840

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    Footnotes

    • Contributors NI conceived the study, secured funding and wrote the first draft. VG and MT conducted the analyses. All authors contributed substantially to the study design, the drafting of the manuscript and approved the final version. Concept and design: NI, MT. Acquisition, analysis or interpretation of data: NI, MT, VG, CR. Drafting of the manuscript: NI, MT, VG. Critical revision of the manuscript for important intellectual content: NI, CR, MT, VG, EW, SB. Statistical analysis: MT, VG. Administrative, technical or material support: NI, CR, SB.

    • Funding Canadian Institutes for Health Research (CIHR) and the Province of Ontario. Ontario Strategy for Patient Oriented Research.

    • Competing interests NI received grant funding for the submitted work from the Ontario Strategy for Patient Oriented Research, which is cofunded by the Canadian Institutes for Health Research (CIHR) and the Ministry of Health and Long-Term Care; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years.

    • Patient consent Not required.

    • Ethics approval Women’s College Hospital Research Ethics Board (Toronto, Ontario, Canada).

    • Provenance and peer review Not commissioned; externally peer reviewed.