Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial

Smeets, Claudia H. W.; Smalbrugge, Martin; Gerritsen, Debby L.; Nelissen-Vrancken, Marjorie; Wetzels, Roland B; Spek, Klaas van der; Zuidema, Sytse U.; Koopmans, Raymond T.C.M.

doi:10.1186/1471-244x-13-280

Cited by 19 publications

(26 citation statements)

References 45 publications

(44 reference statements)

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“…Moreover, the Hawthorne effect may well have been operating such that prescribers, aware that they were being monitored for this trial, merely changed their behavior because, and while, they were being observed not because of the QUM-D per se . If the tool relied on some interactive component, as we demonstrated with use by nursing staff, this would be consistent with hypotheses that successful de-prescribing is reliant on an interactive and multi-disciplinary process, currently being tested in the recent de-prescribing studies (Smeets et al , 2013 ; Brodaty et al , 2014 ).…”

Section: Discussionsupporting

confidence: 81%

“…For example, in the Netherlands, the PROPER II study (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia) is being conducted by pharmacists, physicians, and nurses and has three components: preparation and education, conduct, and evaluation/guidance. Primary outcome measures include percentages of patients with appropriate psychotropic drug use and secondary outcomes include overall frequency of psychotropic drug use, neuropsychiatric symptoms, quality of life, activities of daily living, side effects, and mortality (Smeets et al , 2013 ). In Australia, the HALT (halting antipsychotic use in long term care) (Brodaty et al , 2014 ) and the RedUSe studies ( ) are using similar methodologies of multidisciplinary support teams of nurses, psychiatrists, general practitioners, and pharmacists to reduce the inappropriate use of antipsychotic medication in residential care facilities.…”

Section: Introductionmentioning

confidence: 99%

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The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD)

Peisah

Strukovski

Wijeratne³

et al. 2015

Int. Psychogeriatr.

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Background:Behavioral and psychological symptoms of dementia (BPSD) are virtually ubiquitous in dementia. Excessive recourse to use of psychotropics which have high risk to benefit ratio remains a global problem. We aimed to identify components of quality prescribing in BPSD to develop a tool for quality prescribing and to test this tool.Methods:We used Delphi methodology to identify elements of quality prescribing in BPSD. The tool was tested by a range of medical and nursing professionals on 48 patients, in inpatient and ambulatory settings in Northern Sydney Local Health District, Australia.Results:Consensual opinion using Delphi method was that quality prescribing in dementia comprised ten factors including failure to use first line non-pharmacological strategies, indication, choice of drug, consent, dosage, mode of administration, titration, polypharmacy, toxicity, and review. These elements formed the quality use of medications in dementia (QUM-D) tool, lower scores of which reflected quality prescribing, with a possible range of scores from 0 to 30. When inter-rater reliability was tested on a subgroup of raters, QUM-D showed high inter-rater reliability. A significant reduction in QUM-D scores was demonstrated from baseline to follow-up, mean difference being 5.3 (SD = 3.8; 95% confidence interval 4.1–6.4; t = 9.5; df = 47; p < 0.001). There was also a significant reduction in score from baseline to follow-up when rated by clinical nurse consultants from a specialized behavior assessment management service (BAMS) (N = 12).Conclusion:The QUM-D is a tool which may help to improve quality prescribing practices in the context of BPSD. In this setting, we consider quality prescribing, and accordingly the obligations of prescribers, to be an inclusive concept rather than just adding to the mantra of “not prescribing.”

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD)

Peisah

Strukovski

Wijeratne³

et al. 2015

Int. Psychogeriatr.

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“…Psychotropic drugs and cholinesterase inhibitors are often used to help cognitive function and alleviate NPS in older adults. 35,36 Second, the NPI-Q may be biased by caregiver burden. 37,38 The newer Neuropsychiatric Inventory-Clinician rating scale (NPI-C) may provide a more objective evaluation of NPS.…”

Section: Discussionmentioning

confidence: 99%

Trajectories of Neuropsychiatric Symptoms and Cognitive Decline in Mild Cognitive Impairment

David

Lin

Porsteinsson

2016

The American Journal of Geriatric Psychiatry

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Objective To characterize the course of neuropsychiatric symptoms (NPS) in adults with mild cognitive impairment (MCI), and to examine baseline individual-level predictors and associated cognitive and functional outcomes. Design A two-year prospective cohort study. Setting Multi-center clinical settings. Participants Five hundred and sixty individuals with MCI at baseline. Measurements NPS severity (measured using Neuropsychiatric Inventory Questionnaire) and cognitive and functional outcomes were assessed at baseline and every six months thereafter. Potential individual-level predictors were collected at baseline. Results Three latent classes of NPS courses were identified using growth mixture modeling: a stable class in which a low NPS burden remained relatively unchanged over time (n = 503, 89.8%); a worsened class in which an initially moderate NPS burden increased (n = 39, 7.0%); and an improved class in which an initially high NPS burden decreased (n = 18, 3.2%). There were no associations between class membership and baseline individual characteristics. Members of the worsened class were 1.74 times more likely to be diagnosed with incident Alzheimer’s disease (AD) than members of the stable class (95% CI = 1.07–2.84). The worsened class also showed significantly more rapid declines in cognitive and functional outcomes than the stable class. Class membership did not predict rate of brain atrophy. Conclusions Patients with MCI may experience different trajectories of NPS over time. Patients with worsening NPS may be at greater risk of developing AD and severe cognitive and functional impairment.

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“…Although it might be relevant to distinguish between barriers and facilitators related to the intervention and those related to the implementation strategy, the reviewed articles rarely present their results in this manner. Furthermore, several interventions incorporate elements, such as training (Smeets et al, 2013), that are considered implementation strategies by others (Gerritsen et al, 2011). Further research could explore the added value of this distinction.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Systematic review on barriers and facilitators of complex interventions for residents with dementia in long-term care

Kormelinck

Janus

Smalbrugge

et al. 2020

Int. Psychogeriatr.

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Objectives: Psychotropic drugs are frequently and sometimes inappropriately used for the treatment of neuropsychiatric symptoms of people with dementia, despite their limited efficacy and side effects. Interventions to address neuropsychiatric symptoms and psychotropic drug use are multifactorial and often multidisciplinary. Suboptimal implementation of these complex interventions often limits their effectiveness. This systematic review provides an overview of barriers and facilitators influencing the implementation of complex interventions targeting neuropsychiatric symptoms and psychotropic drug use in long-term care. Design: To identify relevant studies, the following electronic databases were searched between 28 May and 4 June: PubMed, Web of Science, PsycINFO, Cochrane, and CINAHL. Two reviewers systematically reviewed the literature, and the quality of the included studies was assessed using the Critical Appraisal Skills Programme qualitative checklist. The frequency of barriers and facilitators was addressed, followed by deductive thematic analysis describing their positive of negative influence. The Consolidated Framework for Implementation Research guided data synthesis. Results: Fifteen studies were included, using mostly a combination of intervention types and care programs, as well as different implementation strategies. Key factors to successful implementation included strong leadership and support of champions. Also, communication and coordination between disciplines, management support, sufficient resources, and culture (e.g. openness to change) influenced implementation positively. Barriers related mostly to unstable organizations, such as renovations to facility, changes toward self-directed teams, high staff turnover, and perceived work and time pressures. Conclusions: Implementation is complex and needs to be tailored to the specific needs and characteristics of the organization in question. Champions should be carefully chosen, and the application of learned actions and knowledge into practice is expected to further improve implementation.

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Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial

Cited by 19 publications

References 45 publications

The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD)

The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD)

Trajectories of Neuropsychiatric Symptoms and Cognitive Decline in Mild Cognitive Impairment

Systematic review on barriers and facilitators of complex interventions for residents with dementia in long-term care

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