Effect of an Interdisciplinary Educational Program on Antipsychotic Prescribing Among Residents With Dementia in Two Long-Term Care Centers

Abstract

The effect of an educational program on antipsychotic prescribing was assessed in two Canadian long-term care centers (LTCC). In each center (Center A residents, n = 258 and Center B residents, n = 191, with dementia at program inception), the rate of change in the odds of using antipsychotics in residents was estimated using mixed-effects logistic regression during a 6-month program period and a 4-month postprogram period, with baseline proportions of use estimated during the 6 months prior to the program. Preprogram proportions of antipsychotic use were 41.6% and 46.2%, respectively. Antipsychotic use decreased during the program in both centers: (odds ratio with 95% CI: 0.943 per week [0.921, 0.965] and 0.969 per week [0.944, 0.994], respectively). During the postprogram period, antipsychotic use increased in Center A (1.039 per week [1.007, 1.072]) but decreased progressively in Center B. The study results suggest the need to implement an ongoing educational program in LTCC.

Comparing Three Methods for Reducing Psychotropic Use in Older Demented Spanish Care Home Residents

“…Multidisciplinary Medication Reviews or Interdisciplinary Ward Rounds ("Team Rounds") Such programs have been shown to decrease inappropriate medication use among nursing home residents, [13][14][15][16][17][18][19][20][21][22][23][24] particularly for patients whose medication loads have increased over time 25 and those transitioning to nursing homes. 26 We developed a guideline for conducting Team Rounds, the English version of which is available in Supplementary Appendix S1.…”

Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications in People With Dementia Resident in Care Homes: A Systematic Review

“…Results showed similar trends to those seen in studies of a more robust design. These are smaller single 30e32 or 2-center studies 29 involving between 53 and 300 patients and their associated care staff. The interventions resulted in a decrease in antipsychotic use (variously reported) in 3 studies.…”

“…Detail is sparse because these follow-up visits were outside of the formal trial period, but it is likely that the extent to which procedures used during the study continued to be used varied between sites both within the same trial and between trials. For example, Monette and colleagues 29 commented that although staff at the long-term care centers had expressed an intention to adopt some of the program components, none were systematically adopted after the study. In contrast, Rovner and colleagues 39 attribute the maintenance of the effect of the intervention in their study to an ongoing requirement for physicians to complete an "indications and side effects" document for each resident receiving psychoactive medication.…”

Potentially Inappropriate Prescribing Among People with Dementia in Primary Care: A Retrospective Cross-Sectional Study Using the Enhanced Prescribing Database

“…reported that psychiatrists in England felt under pressure to prescribe for PWD experiencing behavioural and psychological symptoms and did not always adopt an evidence-based approach to prescribing activity [13]. Whilst a number of studies have reported on appropriateness of prescribing for PWD, these tend to focus on dementia patients living in long-term care facilities [16,17], those at the end of life [18,19], or those prescribed antipsychotic medications [20,21]. Less attention has been paid to PWD living in their own homes within the primary healthcare setting.…”