The Effect of De-Prescribing Antipsychotics on Health and Quality of Life for People With Dementia

Study Overview
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Brief Summary
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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.

Official Title
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The Effect of De-Prescribing Antipsychotics on Health and Quality of Life for People With Dementia

Conditions
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Alzheimer Disease, Dementia, Prescribing, Off-Label

Intervention / Treatment
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* Behavioral: Overprescribing letter to attributed physician
* Behavioral: Placebo letter to attributed physician


Participation Criteria
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Eligibility Criteria
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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
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Nursing home patients of treated study prescribers<br>Patients attributed to physicians who received overprescribing letters in the primary study who reside in a nursing home. | Behavioral: Overprescribing letter to attributed physician<br>* Letter telling patient's attributed physician they were under review for high prescribing<br>|
| Nursing home patients of control study prescribers<br>Patients attributed to physicians who received placebo letters in the primary study who reside in a nursing home. | Behavioral: Placebo letter to attributed physician<br>* Letter to patient's attributed physician about unrelated Medicare regulation<br>|
| Community-dwelling patients of treated study prescribers<br>Patients attributed to physicians who received overprescribing letters in the primary study who reside in the community. | Behavioral: Overprescribing letter to attributed physician<br>* Letter telling patient's attributed physician they were under review for high prescribing<br>|
| Community-dwelling patients of control study prescribers<br>Patients attributed to physicians who received placebo letters in the primary study who reside in the community. | Behavioral: Placebo letter to attributed physician<br>* Letter to patient's attributed physician about unrelated Medicare regulation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Days of Quetiapine Received | Days of quetiapine received during the outcome measurement period | 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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antipsychotics, alzheimers, dementia, prescribing, deprescribing, nursing homes, long-term care