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July 6, 1994

Legislating Drug Prescribing Practices-Reply

Author Affiliations

Vanderbilt University School of Medicine Nashville, Tenn

JAMA. 1994;272(1):30-31. doi:10.1001/jama.1994.03520010040023

In Reply.  —The primary objective of our study was to determine whether OBRA-87 influenced antipsychotic and other psychotropic drug use in nursing homes. The relationship between staffing and other home variables on the degree of antipsychotic reduction in individual nursing homes is interesting and plausible, but requires verification by others before definitive conclusions can be drawn.We agree with Dr Venable that resident (and staff) outcomes would best determine the appropriateness of the reductions in antipsychotic drug use during implementation of OBRA-87. Unfortunately, Health Care Financing Administration regulations did not include provisions for concurrently evaluating the antipsychotic drug use guidelines (or other aspects) of OBRA-87. However, several lines of evidence suggest that decreases in antipsychotic drug use were not associated with adverse behavioral outcomes. First, OBRA-87 explicitly allows the use of antipsychotic drugs for treatment of behavioral disturbances that interfere with the provision of care. Thus, one would not observe

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