by Anthony Chicotel, CANHR Staff Attorney
Last year, Health Economics published a study that closely examined the impact of statewide deficiency citations on the rate of antipsychotic use in nursing homes. As one would expect, the study’s authors found that increased enforcement actions for misusing antipsychotic drugs correlated with reduced use overall. A ten percentage point increase in the proportion of nursing homes that receive a deficiency for antipsychtoic use was associated with a 0.45 percentage point decrease in antipsychotic usage rates.
What was particularly interesting in the study was the finding that antipsychotic use rates actually grew when non-drug related deficiency citations increased. The authors speculated that non-drug citations force facilities into a “diversion of improvement efforts.” In other words, facilities divert their resources in a way that actually increases their drugging rate in an effort to improve compliance in other regulatory areas.
The study points out the “whac-a-mole” problem with regulatory enforcement. When regulators focus on one area of care, facilities may divert resources and attention from other areas of care. One way to reduce this problem is for regulators to focus on overall dementia care in addition to cracking down on antipsychotic misuse. When a facility has a good, comfort-focused, least medicating approach to dementia care, overall quality of care improves and antipsychotic use rates go down. In these case, improvement efforts are diffuse across multiple care dimensions and score a win-win for residents and their nursing homes.