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Common Sense Reforms Needed to Prevent Inappropriate Use, Support Care for Patients with Dementia

Published February 21, 2023

Older person's hand on shoulder with younger caregiver's hand on top in a caring manner.

WASHINGTON, D.C. (Feb. 21, 2023) — Project PAUSE appreciates Senator Grassley’s dedication to patient safety while residing in nursing homes, especially the potential misuse of antipsychotic medications. Project PAUSE shares this goal and is dedicated to ensuring the best possible patient care.

Project PAUSE (Psychoactive Appropriate Use for Safety and Effectiveness), is an ad hoc coalition of national patient and professional organizations collectively advocating on clinical and regulatory and legislative issues in long-term care.

Unfortunately, the November 2022 HHS Office of Inspector General (OIG) report does not provide evidence to clarify the clinical appropriateness of an antipsychotic medication. These medications are FDA-approved and medically appropriate for many patients, including those with dementia. Unfortunately, the report conflates psychotropic and antipsychotic medication use, allowing for a misinterpretation that reinforces the narrative that the use of antipsychotic drugs, as a whole, is dangerous and should be eliminated.

There is a need for data-backed reforms. Unfortunately, the current nursing home quality measures on the use of antipsychotic medications do not further the goal of ensuring these drugs are used appropriately. In fact, many of the concerns outlined by the OIG report are a result of a measure that has not been endorsed by the National Quality Form and was put in place more than 12 years ago by CMS. The current measures have contributed to the growing use of other, less safe drugs for patients with dementia and the overdiagnosis of exempted diseases, such as schizophrenia.

“Continuing to rely on a quality measure that provides no definition for quality care, nor is endorsed by quality rating organizations, will not drive improved and safer resident care,” said Sue Peschin, MHS, President and CEO of Alliance for Aging Research. “The lack of precision in the measurement leads to inaccurate assessments of quality, reduced appropriate management of mental health conditions, poor resident outcomes, increased health inequities, and preventable harm.”

“Instead of CMS’ current ‘less is better’ approach to quality measurement, it is important to create a companion measure that identifies inappropriate use of these drugs while ensuring that patients with serious mental illness, for whom treatment is indicated and appropriate, have access to it,” said Chad Worz, Executive Director and CEO of the American Society of Consultant Pharmacists. “Project PAUSE looks forward to working with Senator Grassley and CMS to establish a companion measure that reflects best clinical practice rather than a punitive framework that is not focused on resident well-being.” 

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