A long-term care center interdisciplinary education program for antipsychotic use in dementia: program update five years later

Vida, Stephen; Monette, Johanne; Wilchesky, Machelle; Monette, M.; Friedman, Ruby; Nguyen, Anh; Dastoor, Dolly; Cristache, Gabriela; Sourial, Nadia; Tremblay, Lucie; Gore, Brian F.

doi:10.1017/s1041610211002225

Cited by 15 publications

(17 citation statements)

References 25 publications

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“…Our results regarding prevalence of AP use are consistent with previous studies among individuals with dementia [24–27], whereas other authors reported much higher rates of AP use [12, 28–32]. The settings of the present analysis may explain some of the observed discrepancies.…”

Section: Discussionsupporting

confidence: 90%

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Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Tifratene

Manera²,

Fabre

et al. 2017

Alz Res Therapy

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BackgroundSafety warnings from health authorities are currently intended to limit the use of antipsychotics (APs) in dementia-related conditions to treat neuropsychiatric symptoms, such as disturbing and/or delusional behaviors. The aim of this study is to investigate prevalence, correlates and trends of AP prescribing among people with dementia between 2010 and 2014 in the French population.MethodsAP prescribing and associated factors among individuals with AD, mixed dementia and vascular dementia in the French National Alzheimer Database between 2010 and 2014 were analyzed using multivariate generalized estimating equations models (n = 199,549).ResultsIn 2014, 7.7% of people with dementia were prescribed an AP. Compared with 2010 there was a 16% increase in AP use. Multivariate analysis showed a linear increase risk of prescription with an adjusted odds ratio (95% confidence interval) of 1.23 (1.17–1.30) in 2014 compared with 2010. Factors associated with AP prescribing were male gender, more severe cognitive decline and living in long-term care facilities. Older age and higher education were protective toward AP prescribing. The type of dementia did not have any influence on AP prescribing.ConclusionAn increase in AP prescribing among individuals with dementia in French specialized settings over the last 5 years occurred despite safety warnings. This phenomenon suggests that alternative solutions for the management of behavioral and psychiatric symptoms in these populations are still urgently needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-017-0256-8) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

“…If the efficacy of safety warnings issued by health authorities in reducing AP use is controversial, some targeted educational interventions aimed at health care professionals and at a local level have shown a relative efficacy if provided regularly [14, 27]. …”

Section: Discussionmentioning

confidence: 99%

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Tifratene

Manera²,

Fabre

et al. 2017

Alz Res Therapy

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“…A total of 13 studies were included (table 2). 23–35 These 13 studies were published between 2002 and 2016 (six studies within the last decade). Studies were conducted in the USA (6),23–28 Australia (2),29 30 Canada (2)31 32 and the Netherlands (3) 33–35…”

Section: Resultsmentioning

confidence: 99%

“…Studies’ methodologies varied across chronic diseases, study design and duration, sample selection, number and type of CCM10 components used in the intervention(s), and intervention activities (table 1). The majority of studies (76.9%) focused on management of dementia 23 24 26 27 29–31 33–35. Two studies25 32 focused on managing diabetes mellitus and one study28 evaluated the management of heart failure.…”

Section: Resultsmentioning

confidence: 99%

Chronic disease management models in nursing homes: a scoping review

et al. 2020

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ObjectivesNursing home (NH) residents experience a high burden of chronic disease. Chronic disease management (CDM) can be a challenge, as the context of care provision and the way care is provided impact care delivery. This scoping review aimed to identify types of chronic diseases studied in intervention studies in NHs, influential contextual factors addressed by interventions and future CDM research considerations.DesignThe scoping review followed guidelines by Arksey and O’Malley (2005) and Levac, Colquhoun and O’Brien (2010). Six reviewers screened citations for inclusion. Data extraction was performed by one reviewer and verified by a second reviewer.Data sourcesWe searched four databases: CINAHL, EMBASE, PubMed and Scopus, in March 2018.Eligibility criteriaStudies were included if (1) aim of intervention was to improve CDM, (2) intervention incorporated the chronic care model (CCM), (3) included NH residents, (4) analysed the efficacy of the intervention and (5) sample included adults over age 65 years. Studies were limited to English or French language and to those published after 1996, when the CCM was first conceptualised.Data extraction and synthesisExtracted information included the type of chronic disease, the type and number of CCM model components used in the intervention, the method of delivery of the intervention, and outcomes.ResultsOn completion of the review of 11 917 citations, 13 studies were included. Most interventions targeted residents living with dementia. There was significant heterogeneity noted among designs, outcomes, and type and complexity of intervention components. There was little evaluation of the sustainability of interventions, including feasibility.ConclusionsResearch was heavily focused on management of dementia. The most commonly included CCM components were multidisciplinary care, evidence-based care, coordinated care and clinical information systems. Future research should include subjective and objective outcomes, which are meaningful for NH residents, for common chronic diseases.

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“…A recent systematic review identified 22 interventions that have been developed to address inappropriate antipsychotic use in nursing homes [ 4 ]. This review noted that medication audit initiatives typically collect data by visiting the home and copying resident charts [ 4 , 10 , 11 ] using cohorts already detailed by other studies [ 12 , 13 ] or by accessing electronic pharmacy records [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

An Internet-Based Method for Extracting Nursing Home Resident Sedative Medication Data From Pharmacy Packing Systems: Descriptive Evaluation

et al. 2017

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BackgroundInappropriate use of sedating medication has been reported in nursing homes for several decades. The Reducing Use of Sedatives (RedUSe) project was designed to address this issue through a combination of audit, feedback, staff education, and medication review. The project significantly reduced sedative use in a controlled trial of 25 Tasmanian nursing homes. To expand the project to 150 nursing homes across Australia, an improved and scalable method of data collection was required. This paper describes and evaluates a method for remotely extracting, transforming, and validating electronic resident and medication data from community pharmacies supplying medications to nursing homes.ObjectiveThe aim of this study was to develop and evaluate an electronic method for extracting and enriching data on psychotropic medication use in nursing homes, on a national scale.MethodsAn application uploaded resident details and medication data from computerized medication packing systems in the pharmacies supplying participating nursing homes. The server converted medication codes used by the packing systems to Australian Medicines Terminology coding and subsequently to Anatomical Therapeutic Chemical (ATC) codes for grouping. Medications of interest, in this case antipsychotics and benzodiazepines, were automatically identified and quantified during the upload. This data was then validated on the Web by project staff and a “champion nurse” at the participating home.ResultsOf participating nursing homes, 94.6% (142/150) had resident and medication records uploaded. Facilitating an upload for one pharmacy took an average of 15 min. A total of 17,722 resident profiles were extracted, representing 95.6% (17,722/18,537) of the homes’ residents. For these, 546,535 medication records were extracted, of which, 28,053 were identified as antipsychotics or benzodiazepines. Of these, 8.17% (2291/28,053) were modified during validation and verification stages, and 4.75% (1398/29,451) were added. The champion nurse required a mean of 33 min website interaction to verify data, compared with 60 min for manual data entry.ConclusionsThe results show that the electronic data collection process is accurate: 95.25% (28,053/29,451) of sedative medications being taken by residents were identified and, of those, 91.83% (25,762/28,053) were correct without any manual intervention. The process worked effectively for nearly all homes. Although the pharmacy packing systems contain some invalid patient records, and data is sometimes incorrectly recorded, validation steps can overcome these problems and provide sufficiently accurate data for the purposes of reporting medication use in individual nursing homes.

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A long-term care center interdisciplinary education program for antipsychotic use in dementia: program update five years later

Abstract: Despite the low prevalence (17.2%) of AP users at the beginning of the current study compared to that observed five years prior (30.5%), it is still possible to further decrease the proportion of users.

Cited by 15 publications

References 25 publications

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Antipsychotic prescribing for Alzheimer’s disease and related disorders in specialized settings from 2010 to 2014 in France: a repeated cross-sectional study

Chronic disease management models in nursing homes: a scoping review

An Internet-Based Method for Extracting Nursing Home Resident Sedative Medication Data From Pharmacy Packing Systems: Descriptive Evaluation

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