Alzheimer Disease, Dementia, Prescribing, Off-Label
Conditions
Keywords
antipsychotics, alzheimers, dementia, prescribing, deprescribing, nursing homes, long-term care
Brief summary
This study aims to analyze how warning letters sent to physicians prescribing high levels of the antipsychotic quetiapine affected the health and quality of life of their patients with dementia. Using a randomized controlled trial conducted by the Centers for Medicare and Medicaid Services (CMS) in 2015, this secondary study looks at the effects of potential de-prescribing of antipsychotics by study physicians induced by the letters. The central question is whether the intervention led to better health and quality of life outcomes by encouraging more guideline-concordant care and whether changes in physicians' prescription behavior caused unintended harms.
Interventions
BEHAVIORALOverprescribing letter to attributed physician
Letter telling patient's attributed physician they were under review for high prescribing
BEHAVIORALPlacebo letter to attributed physician
Letter to patient's attributed physician about unrelated Medicare regulation
Sponsors
National Bureau of Economic Research, Inc.
Harvard School of Public Health (HSPH)
National Institute on Aging (NIA)
Columbia University
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* Fully enrolled in Fee-For-Service Medicare Parts A, B, and D * For nursing home patients: Residing in a nursing home and has a usable nursing home assessment to measure outcomes * For community-dwelling patients: Not residing in a nursing home * Has Alzheimer's or dementia related disease diagnosis * Attributed to study physician (see study population description)
Exclusion criteria
* Died during 90 day period used to attribute patient to physician * For nursing home patients: Short-stay nursing facility patient
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Days of Quetiapine Received | 90 days | Days of quetiapine received during the outcome measurement period |
Countries
United States
Outcome results
None listed