Article Text
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
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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.