A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes

From the New England Journal of Medicine

ByJerry Avorn, MD; Stephen B. Soumerai, MSPH; D. Everitt; D. Ross-Degnan; M.H. Beers; D. Sherman; et al.

SUMMARY: This NEJM research article reports a randomized controlled trial in which an academic-detailing educational program was tested in nursing homes to reduce the inappropriate use of psychoactive (sedating) medications in elderly residents. Avorn, Soumerai, and colleagues randomized nursing homes and tracked prescribing outcomes, demonstrating that targeted educational outreach to nursing-home staff and prescribers could produce measurable reductions in problematic sedating drug use. This study is a key example of academic detailing applied in a long-term care setting, and it complements the foundational 1983 NEJM trial by demonstrating the model's effectiveness beyond the office-based setting. The co-author list includes Mark Beers, whose subsequent work led to the widely used Beers Criteria for potentially inappropriate medications in older adults.

BACKGROUND: Psychoactive medications — including sedatives, hypnotics, and antipsychotics — were frequently and often inappropriately prescribed to elderly nursing-home residents, contributing to falls, cognitive impairment, and other adverse outcomes.

KEY FINDINGS: An academic-detailing educational outreach program randomized to nursing homes produced measurable reductions in the overuse of sedating psychoactive medications among elderly residents.

IMPLICATIONS: Academic detailing is effective not only in office-based physician settings but also in institutional long-term care settings, offering a replicable model for reducing inappropriate psychoactive prescribing in nursing homes.