Exploring Antipsychotic Prescribing Behaviors for Nursing Home Residents With Dementia: A Qualitative Study

Walsh, Kieran; Sinnott, Carol; Fleming, Aoife; McSharry, Jennifer; Byrne, Stephen; Browne, John; Timmons, Suzanne

doi:10.1016/j.jamda.2018.07.004

Cited by 26 publications

(66 citation statements)

References 40 publications

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“…It was difficult to determine how the 'Intentions' and 'Optimism' domains influenced GPs' and community pharmacists' behaviour; these domains were also amongst the least frequently discussed by interview participants. Other studies exploring prescribing for older people have also found these domains to not be relevant [47,48]. In selecting key domains, we noted that some of the barriers and facilitators reported by HCPs impacted on a number of different domains.…”

Section: Self-monitoring Of Behaviour Memory Attention and Decision mentioning

confidence: 87%

Improving medicines management for people with dementia in primary care: a qualitative study of healthcare professionals to develop a theory-informed intervention

Barry

Bedford

McGrattan

et al. 2020

BMC Health Serv Res

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Background: People with dementia (PwD) face unique challenges with medicines management, yet little is known about these challenges from the perspectives of primary healthcare professionals, particularly general practitioners (GPs) and community pharmacists. Few medicines management interventions have been developed which are aimed at community-dwelling PwD. This study sought to develop an intervention to improve medicines management for PwD in primary care using a theory-informed approach. Methods: Semi-structured interviews were conducted with GPs (n = 15) and community pharmacists (n = 15) to explore participants' views and experiences of medicines management for PwD, and their perceptions of barriers and facilitators to successful medicines management for PwD. The 14-domain Theoretical Domains Framework was the underpinning theoretical guide, allowing key theoretical domains to be identified and mapped to behaviour change techniques (BCTs) which are considered the 'active ingredients' of an intervention. Draft interventions were developed to operationalise selected BCTs and were presented to GPs and community pharmacists during task groups. Final selection of an intervention for feasibility testing was guided by feedback provided during these task groups and through application of the APEASE (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity) criteria. Results: Participants expressed a number of concerns about medicines management for PwD, particularly monitoring adherence to medication regimens and conducting medication review. Two draft interventions comprising selected BCTs ('Modelling or demonstration of behaviour'; 'Salience of consequences'; 'Health consequences'; 'Social and environmental consequences'; 'Action planning'; Social support or encouragement', 'Self-monitoring of behaviour') were developed, each targeting GPs and community pharmacists. Following the task groups and discussions within the research team, the community pharmacy-based intervention was selected for future feasibility testing. The intervention will target community pharmacists to conduct a medication review (incorporating an adherence check) with a PwD, delivered as an online video demonstrating key behaviours. The video will include feedback emphasising positive outcomes of performing the behaviours. Action planning and a quick reference guide will be used as complementary intervention components.

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Section: Self-monitoring Of Behaviour Memory Attention and Decision mentioning

confidence: 87%

Improving medicines management for people with dementia in primary care: a qualitative study of healthcare professionals to develop a theory-informed intervention

Barry

Bedford

McGrattan

et al. 2020

BMC Health Serv Res

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“…In this study, ‘increased staffing levels’ was the number one recommendation of participating GPs when asked what would help to reduce the prescribing of psychotropic medications in dementia. Previous studies have identified that chronic understaffing in nursing homes can hinder the nursing staff’s ability to implement non-pharmacological strategies [ 32 ] and, thus, increase pressure on GPs to prescribe sedative psychotropic medications [ 26 , 29 ]. It is likely that the prescribing pressure the GP feels from the nursing staff is a combination of all these factors; the experience level of the GP, the relationship between the nurse and the GP, and the resource constraints of the nursing home [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

General practitioners’ knowledge of and attitudes towards prescribing psychoactive drugs in dementia care: a cross-sectional questionnaire study

2020

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Background Despite their adverse effects, antipsychotics are frequently prescribed to manage behavioural and psychological symptoms of dementia (BPSD). At present, we do not have a good understanding of general practitioners' (GPs) current management of BPSD. Aims To explore the knowledge, attitudes, and opinions of GPs regarding the prescribing of psychoactive drugs in managing BPSD. Methods This was a descriptive cross-sectional study. A questionnaire was adapted from a previous study and piloted with three GPs and was posted to a census sample of all GPs working in counties Cork and Kerry, Ireland. We collected and analysed both quantitative and qualitative data. Results Of the 456 eligible GPs who received the questionnaire, 168 GPs returned completed questionnaires (response rate 36.8%). All respondents (100%, 168/168) believed that antipsychotics did not benefit all patients with BPSD. The majority of GPs (69%, 116/168) routinely recommended non-pharmacological interventions before medication to manage BPSD. Most GPs (60.7%, 102/168) welcomed more training and experience to improve their management of BPSD. The qualitative comments provided by GPs described a pressure to prescribe from nursing home staff. GPs highlighted that the management of BPSD is difficult in daily practice and felt that antipsychotics still have a role to play. Conclusions This study identified several factors influencing the prescription of antipsychotics for patients with BPSD as well as the prescribing dilemmas faced by GPs in their daily practice. These findings can be used to guide future interventions aimed at reducing inappropriate prescribing in dementia care.

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“…Personal autonomy of the resident needs to be respected, however the safety of the resident and others needs to be considered, and this can be challenging in the context of BPSD 22 . The nursing home regulator in Ireland, the Health Information and Quality Authority (HIQA) mandates the reporting of chemical and physical restraint usage in nursing homes 30 , though this presents its own challenges as reporting guidance is considered to be non-specific 22 , and any instance of restraint usage is self-reported by the nursing home 22 . There has been a recent impetus for change in the system, with the launch of the Irish National Dementia Strategy in 2014 which identified inappropriate antipsychotic prescribing as a priority for action 31 .…”

Section: Resultsmentioning

confidence: 99%

“…The intervention is primarily targeted at nurses and GPs who provide care to nursing home residents with dementia. This is based on our previous qualitative findings which found that these two key stakeholder groups are the most central to the decision to request or prescribe an antipsychotic to a resident with dementia 21 , 22 . While the main target within the nursing home setting were nurses given their role in medication management, we considered that involving others that work in nursing homes (such as healthcare assistants) may be an important way of restructuring the social environment and promoting behaviour change 19 .…”

Section: Resultsmentioning

confidence: 99%

“…The UK Medical Research Council framework and Behaviour Change Wheel approach guided our intervention development process from start to finish, while the Theoretical Domains Framework was used specifically during our primary qualitative study to identify the behavioural determinants of appropriate requesting and prescribing of antipsychotics to nursing home residents with dementia 22 . The remaining frameworks and tools (i.e.…”

Section: Methodsmentioning

confidence: 99%

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Developing a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia

et al. 2021

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Background: Antipsychotics are commonly prescribed to people living with dementia in nursing home settings, despite strong guideline recommendations against their use except in limited circumstances. We aimed to transparently describe the development process for a complex intervention targeting appropriate requesting and prescribing of antipsychotics to nursing home residents with dementia in Ireland, by nurses and general practitioners (GPs) respectively. Methods: We report the development process for the ‘Rationalising Antipsychotic Prescribing in Dementia’ (RAPID) complex intervention, in accordance with the ‘Guidance for reporting intervention development studies in health research’ (GUIDED) checklist. The UK Medical Research Council framework for developing and evaluating complex interventions guided our overall approach, incorporating evidence and theory into the intervention development process. To unpack the intervention development process in greater detail, we followed the Behaviour Change Wheel approach. Guided by our stakeholders, we conducted three sequential studies (systematic review and qualitative evidence synthesis, primary qualitative study and expert consensus study), to inform the intervention development. Results: The RAPID complex intervention was developed in collaboration with a broad range of stakeholders, including people living with dementia and family carers, between 2015 and 2017. The finalised RAPID complex intervention was comprised of the following three components; 1) Education and training sessions with nursing home staff; 2) Academic detailing with GPs; 3) Introduction of an assessment tool to the nursing home. Conclusions: This paper describes the steps used by the researchers to develop a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia in Ireland, according to the GUIDED checklist. We found that the GUIDED checklist provided a useful way of reporting all elements in a cohesive manner and complemented the other tools and frameworks used. Transparency in the intervention development processes can help in the translation of evidence into practice.

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Exploring Antipsychotic Prescribing Behaviors for Nursing Home Residents With Dementia: A Qualitative Study

Cited by 26 publications

References 40 publications

Improving medicines management for people with dementia in primary care: a qualitative study of healthcare professionals to develop a theory-informed intervention

Improving medicines management for people with dementia in primary care: a qualitative study of healthcare professionals to develop a theory-informed intervention

General practitioners’ knowledge of and attitudes towards prescribing psychoactive drugs in dementia care: a cross-sectional questionnaire study

Developing a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia

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