Antipsychotic use in the absence of symptoms or diagnoses related to psychosis is generally regarded as an inappropriate approach to care of older adults in nursing homes. The Canadian Foundation for Healthcare Improvement (CFHI) launched a pan-Canadian intervention study to reduce antipsychotic use in long-term care based on promising pilot study results from the Winnipeg Regional Health Authority (WRHA). Data from the Continuing Care Report System (CCRS) managed by the Canadian Institute for Health Information (CIHI) were used to compare the characteristics of residents in intervention homes with control homes not in the study. The sample was comprised of 5,434 residents in 49 intervention homes compared with 123,781 residents in 1,193 control homes. Resident-level comparisons included demographic, diagnostic, and clinical indicators. Facility-level comparisons included nine risk-adjusted quality indicators. The main differences of note were in geographic representation (Ontario homes were underrepresented), access to rehabilitation, and discharge patterns (both of which were related to Ontario practice patterns). There were few substantial differences in quality indicator performance between homes by study participation prior to the onset of the intervention. The study protocol used in this pan-Canadian intervention was based on a successful, small-scale pilot undertaken in one province. Sites that participated in the intervention did not differ in substantively meaningful ways from control homes. Therefore, subsequent study findings after the intervention are unlikely to be attributable to differences between homes that existed prior to the study onset.
Competing Interest: Authors declare no competing interest. Funders had no role in study design, collection and interpretation of data and manuscript writing. One of the authors (CS) is currently working with CEPF-ATREE. However she was not associated with this organization, during the time, the study was carried out.Author Contribution: AK and RR were involved in designing the study. AK, CS, AP and RR undertook the surveys. AK, RP, CS, AP and RR were involved in manuscript preparation. Acknowledgements:The first author would like to thank Bhaskar Acharya, Vijayalakshmi, P.A. Kanagavel, Anvar Ali and Shrinivas Kadabagere for their help and support during the study; Varun Vikraman for volunteering on the surveys and Sethu Parvathy for her suggestions on the manuscript. The second author would like to thank Mamata Pandya for her comments on the manuscript. The authors would like to thank the two anonymous reviewers and the Subject Editor for their comments and suggestions that have improved this article. Abstract: Community Reserves and ConservationReserves illustrate a community-based co-management model, a first of its kind within the protected area (PA) network of India. Such reserves mark a shift towards an inclusive and decentralised approach within PAs in the country. Three such reserves in southern India: the Aghanashini Lion-tailed Macaque Conservation Reserve, Kadalundi-Vallikunnu Community Reserve and Thirupaddaimaradur Conservation Reserve, were selected to examine the reasons for their creation, management and stakeholder dynamics, with an aim to review their productivity and potential replicability. The study was carried out through semi-structured interviews with Forest Department officials, local community members and researchers working in the three reserves. Insufficient interaction between the stakeholders appeared to be a common issue in two reserves. The functioning of the reserves was also influenced, and in some cases negatively affected, by local politics. Financial stability was crucial in the functioning of reserves, as was consistency in interaction and appropriate monitoring of management plans. These elements are recommended for sustaining such reserves and creating communitybased management systems for conservation, to support an inclusive approach to PA management.
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