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Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education
Ray WA, Taylor JA, Meador KG, Lichtenstein MJ, Griffin MR, Fought R, Adams ML, Blazer DG.. Archives of internal medicine, 1993-03-01
Topic: Risk, prevention and care in population studies
Objective In the United States, 20% or more of nursing home residents receive antipsychotic drugs, primarily for the behavioral manifestations of dementia. This high level of use of drugs with substantial toxicity has engendered a strong and persistent controversy and recently has led to explicit regulatory measures to curtail use (Omnibus Budget Reconciliation Act of 1987). We developed and tested a comprehensive program to reduce antipsychotic use through education of physicians, nurses, and other nursing home staff. The primary elements of the program were instruction in use of behavioral techniques to manage behavior problems and encouragement of a trial of gradual antipsychotic withdrawal. Design In a nonrandomized controlled trial, the program was implemented (beginning in August 1990) in two rural Tennessee community nursing homes with elevated antipsychotic use; two other comparable homes were selected as concurrent controls. Patients Throughout the study 194 residents were in the education homes and 184 were in the control homes. Residents in both groups of homes had comparable demographic characteristics and functional status, and each group had a baseline rate of 29 days of antipsychotic use per 100 days of nursing home residence. Main outcome measures The primary end points were postintervention changes in administration of antipsychotics and other psychotropic drugs, use of physical restraints, and frequency of behavior problems. Results Days of antipsychotic use decreased by 72% in the education homes vs 13% in the control homes (P Conclusions The educational program led to a substantial reduction in antipsychotic use with no increase in the frequency of behavior problems. This suggests that for many antipsychotic drug users benefits may be marginal and that programs to reduce such drug use among the 250,000 US nursing home residents receiving these drugs should have high priority.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Ray, W. A., Taylor, J. A., Meador, K. G., Lichtenstein, M. J., Griffin, M. R., Fought, R., et al. (1993). Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education. Archives of internal medicine. https://doi.org/10.1001/archinte.1993.00410060023005
Vancouver
Ray WA, Taylor JA, Meador KG, Lichtenstein MJ, Griffin MR, Fought R, et al. Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education. Archives of internal medicine. 1993. doi:10.1001/archinte.1993.00410060023005. PMID: 8447709.
BibTeX
@article{ray1993-8447709,
author = {Ray, W. A. and Taylor, J. A. and Meador, K. G. and Lichtenstein, M. J. and Griffin, M. R. and Fought, R. and Adams, M. L. and Blazer, D. G.},
title = {{Reducing antipsychotic drug use in nursing homes. A controlled trial of provider education}},
journal = {Archives of internal medicine},
year = {1993},
doi = {10.1001/archinte.1993.00410060023005},
pmid = {8447709},
url = {https://doi.org/10.1001/archinte.1993.00410060023005}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
Key findings
- Results Days of antipsychotic use decreased by 72% in the education homes vs 13% in the control homes (P Conclusions The educational program led to a substantial reduction in antipsychotic use with no increase in the frequency of behavior problems.
- This suggests that for many antipsychotic drug users benefits may be marginal and that programs to reduce such drug use among the 250,000 US nursing home residents receiving these drugs should have high priority.
Why it matters
An education program for nursing home staff reduced the use of antipsychotic drugs given for behavioral symptoms of dementia, without an increase in behavior problems. This suggests that for many residents these drugs may offer limited benefit and that programs to reduce their use should be a high priority.
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Study details
- Effect sizedecreased by 72%
- Evidence strengthLow
How this study scored 47/100
Published in a peer-reviewed journal. Scored zero for study design, sample size and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Archives of internal medicine) |
| Journal's citation record | 3 / 4 | Archives of Internal Medicine: journal h-index 462 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1993 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (pubmed indexes it as a clinical or observational study) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 5 / 7 | Cited 160 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 4.6 citations a year over 35 year(s) since 1993 |
| Impact for its field and year | 5 / 6 | Cited 31.3× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 4 other studies in this library |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Wayne A. Ray: h-index 86 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Vanderbilt University: institution h-index 1,199 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 8447709) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 47 / 100 | — |
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