Warning letters from Medicare can safely cut overprescribing of powerful but risky antipsychotics, according to a new study at Columbia University Mailman School of Public Health.

The researchers evaluated a large clinical trial in which Medicare sent warning letters to high prescribers of quetiapine, the most popular antipsychotic in the US. The results were striking. “People with dementia living in nursing homes and in the community were prescribed less and we did not detect negative health impacts for these groups,” said Michelle Harnisch, research student at the London School of Economics and first author of the study.

To test whether the warning letters reduced prescribing safely, the researchers used administrative data from Medicare to link the 5,055 physicians in the original trial to the Medicare records of their patients with dementia. They ultimately analyzed 84,881 patients in nursing homes and 261,288 patients living in the community.

The intervention reduced quetiapine use among nursing home patients by 7% and community-dwelling patients by 15%. The researchers did not find adverse effects across numerous health outcomes, including cognitive function, behavioral symptoms, depression, or metabolic outcomes like diabetes. There were signs of improved mental health outcomes, and the risk of death for patients living in the community fell slightly.

Antipsychotics have a number of well-known risks, including weight gain, cognitive decline, falls, and death. Physician specialty societies, government regulators, and policymakers have aimed to reduce prescribing of these medications to people with dementia.

To download the full article, published in JAMA Network Open, click here