Changes in antipsychotic drug use in nursing homes during implementation of the OBRA-87 regulations

JAMA. 1994 Feb 2;271(5):358-62.


Objectives: To describe the changes in antipsychotic drug use in nursing homes during the period surrounding the implementation of federal legislation designed to reduce unnecessary use (the Omnibus Budget Reconciliation Act of 1987 [OBRA-87]) and to identify nursing home characteristics associated with such changes.

Design: Longitudinal study of 9432 Tennessee Medicaid enrollees 65 years of age or older who continuously resided in Tennessee from April 1, 1989, to September 30, 1991, a 30-month period surrounding implementation of OBRA-87.

Main outcome measures: Changes in the use of antipsychotic and other psychotropic drugs.

Results: During the 30-month period, antipsychotic drug use decreased from 23.9 to 17.5 days per 100 days of residence, a 26.7% decline (P < .001), which resulted from both a decrease in new users (P < .001) and a reduction in long-term use of antipsychotic drugs (P < .001). There was no concomitant increase in other psychotropic drug use. A multivariate analysis revealed that changes in antipsychotic use were strongly associated with baseline antipsychotic use (P = .001) and third-shift staffing levels (P = .003). Nursing homes with baseline antipsychotic drug use and third-shift staffing above the median reduced antipsychotic drug use by 41%, compared with a 2% increase in nursing homes where both of these factors were below the median (P < .0001).

Conclusions: A substantial decrease in antipsychotic drug use coincided with the implementation of OBRA-87. Although this decrease is consistent with an improvement in quality of nursing home care, further research is needed to determine the effects of this legislation on resident outcomes.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Drug Utilization Review / legislation & jurisprudence
  • Drug Utilization Review / statistics & numerical data
  • Drug Utilization Review / trends*
  • Homes for the Aged / legislation & jurisprudence
  • Homes for the Aged / statistics & numerical data
  • Homes for the Aged / trends*
  • Humans
  • Longitudinal Studies
  • Medicaid / legislation & jurisprudence
  • Multivariate Analysis
  • Nursing Homes / legislation & jurisprudence
  • Nursing Homes / statistics & numerical data
  • Nursing Homes / trends*
  • Practice Patterns, Physicians' / legislation & jurisprudence
  • Practice Patterns, Physicians' / trends*
  • Psychotropic Drugs / supply & distribution
  • Psychotropic Drugs / therapeutic use*
  • Tennessee
  • United States


  • Psychotropic Drugs