Telemedicine Can Significantly Reduce High-Risk Medication Use in SNFs — Including Antipsychotics

The value of telehealth in the skilled nursing setting has become apparent during the COVID-19 pandemic, with various care providers finding ways to maintain resident services despite being forced to stay away from facilities.

And in one analysis that began a few months before visitors and unnecessary personnel were banned from SNFs, the telehealth model proved valuable in managing medications in that setting — specifically cutting overall psychotropic medication use by 17% overall in a cohort of 50 SNFs.

The analysis came from the telehealth behavioral provider MediTelecare, which provides behavioral telehealth services to skilled nursing and assisted living facilities in 18 states. For the report, the company drew from a cohort of approximately 1,350 residents, who were referred to MediTelecare for behavioral telehealth services by the staff at the facilities.

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These residents were treated with a 90- to 180-day protocol of telehealth sessions, with a team of psychologists and medical providers such as psychiatrists and nurse practitioners. The focus was on transitioning patients from high-risk medications such as antipsychotics and hypnotics to either less dangerous medications or non-pharmacologic options, MediTelecare chief informatics and compliance officer Dr. Jessica Badichek told Skilled Nursing News on September 16.

MediTelecare has an internal prescribing formulary — or a list of approved medications that have been found to be evidence-based and effective and safe — that provides specific guidance for prescribers, nurse practitioners, and psychiatrists, focused on safe medication use in elderly residents.

“Our prescribers do follow that formulary, as well as all of our medical protocols,” said Badichek, who has a doctor of pharmacy degree and helped develop that formulary. “Within that protocol, we have kind of our interdisciplinary team … Each facility that we provide services in gets an assigned psychologist or clinical social worker to the building, as well as either a nurse practitioner or psychiatrist. So we focus on really that team based approach in in treating the residents, focusing on a lot on the non-pharmacologic options on the psychology side.”

Prescriptions for medications are used when appropriate, she added, but by focusing on the use of such tools as talk therapy or cognitive behavioral testing, MediTelecare is better able to focus on reducing medications like antipsychotics or anti-anxiety medications.

Facilities in the cohort MediTelecare studies averaged 7.21% antipsychotic use, or half the 2019 national average of 14.3% as measured by the Centers for Medicare & Medicaid Services’ (CMS) October 2019 antipsychotic medication use data report. There was also a subgroup of more than 300 patients within that cohort where antipsychotic use dropped anywhere from 32% to 64%.

In addition, the use of anti-anxiety and hypnotic medications declined by about 15% in the cohort. Overall psychotropic medication was reduced by about 17% in patients receiving three or more such drugs, according to MediTelecare.

MediTelecare provides equipment to the facilities where it provides services, according to Badicheck, and so-called “clinical support specialists” to ensure tech support for each tele-visit.

The study began in 2019 and ended in June of this year, but the presence of the pandemic did not seem to affect the reductions, which continued during the months of COVID-19 in spring, Badichek told SNN.

SNFs have come under fire for the use of antipsychotic medications in their residents, with the non-governmental organization Human Rights Watch estimating that 179,000 people in U.S. nursing facilities are inappropriately given antipsychotic drugs in 2018. A 2020 report from the House Ways and Means Committee Majority estimated that 20% of residents were receiving some form of antipsychotic medication though only 2% qualified for some form of these drugs.

That said, the use of antipsychotics in nursing homes did drop from 26% in 2005, as a result of a push by CMS to reduce the use of such medications, according to a study published in JAMDA, the Journal of Post-Acute and Long-Term Care Medicine, in February.

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