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Judith Garrard, PhD; Lukas Makris; Trudy Dunham, MS; Leonard L. Heston, MD; Susan Cooper, MS; Edward R. Ratner, MD; Daniel Zelterman, PhD; Robert L. Kane, MD

JAMA. 1991;265(4):463-467.

Abstract
Federal regulations for use of neuroleptic drugs in Medicare- and Medicaidcertified nursing homes throughout the United States were implemented October 1,1990. These regulations constitute the first time that prescription drugs are required, by law, to be justified by indications documented in the medical chart. This study used extant data to estimate ineligible neuroleptic use at the individual and nursing home levels had these regulations been in effect in 1976 through 1985. Subjects, randomly sampled admissions (N = 5752) and residents (N = 3191), were followed up for up to 24 months in 60 nursing homes. One half of neuroleptic use in each cohort could be considered ineligible under the regulations; all but one of the nursing homes had one or more individuals who were treated with the ineligible use of neuroleptics. Improvements in documentation and/or prescription of neuroleptic drugs for nursing home elderly will be needed to ensure compliance with these new regulations.

(JAMA. 1991;265:463-467)

Author Affiliations
From the Division of Health Services Research and Policy, School of Public Health (Drs Garrard and Kane), the Department of Applied Statistics, School of Statistics (Mr Makris), the Department of Educational Psychology, College of Education (Ms Dunham), the Department of Pharmacy Practice, College of Pharmacy, and the Department of Clinical Pharmacy, St Paul-Ramsey Medical Center, St Paul, Minn (Ms Cooper), the Abbott Northwestern Hospital, Minneapolis, Minn (Dr Ratner), and the Division of Biostatistics, School of Public Health (Dr Zelterman), University of Minnesota, Minneapolis; and The Washington Institute for Mental Illness Training and Research, University of Washington, Seattle (Dr Heston).

Footnotes
Mr Makris is now affiliated with Merck Sharp & Dohme Research Laboratories, West Point, Pa.

The statements contained in this report are solely those of the authors and do not necessarily reflect the views or policies of the Health Care Financing Administration. The authors assume responsibility for the accuracy and completeness of the information contained in this report.

Reprint requests to Division of Health Services Research and Policy, School of Public Health, 420 Delaware St SE, Box 729 Mayo, University of Minnesota, Minneapolis, MN 55455-0392 (Dr Garrard).

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