Off-label use of antipsychotic medications across long-term care settings in korea

Introduction: Off-label use of antipsychotic medications refers to the utilization of drugs for an unapproved indication. Mitigating psychiatric conditions are often a reason for off-label use, which can cause unintended safety issues. The purpose of this study is to examine the prevalence and variations of off-label use of antipsychotics among older people with long-term care needs in nursing home (NH) and long-term care hospital (LTCH) settings. Method: We conducted a nationally representative sample survey of 2,542 older people in 91 NHs (n=1,275) and 52 LTCHs (n=1,267) in South Korea in 2013, including comprehensive geriatric assessments and medication order reviews. Off-label use of antipsychotics was defined by applying the FDA’s 2005 “black box warning.” We calculated at the organizational level the prevalence of off-label use of antipsychotics and the interquartile range of the prevalence. Results: The overall percentage of older people receiving antipsychotics for unapproved indications was 16.9%, and the prevalence was similar at NHs (16.4%) and LTCHs (17.3%). The variance in mean prevalence of off-label use of antipsychotics in both settings was large, and it was larger at NHs than LTCHs even after adjusting for individual characteristics. Conclusion: Preliminary evidence suggests that organizational characteristics affect antipsychotic prescribing independent of resident case-mix. Additional research on off-label use of antipsychotics in LTC settings is needed.