Predictors of Antipsychotic Withdrawal or Dose Reduction in a Randomized Controlled Trial of Provider Education

Meador, Keith G.; Taylor, Jo A.; Thapa, Purushottam B.; Fought, Randy L.; Ray, Wayne A.

doi:10.1111/j.1532-5415.1997.tb04509.x

Cited by 59 publications

(51 citation statements)

References 13 publications

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“…Changes in prescribing have been found for about 5% of patients of general medical practices that have received academic detailing, although some studies demonstrated changes in prescribing practices that affected as many as 50% of patients (14). When delivered with additional intensive training, academic detailing reduced use of antipsychotics among elderly nursing home residents (15). In contrast, a recent study found that four inperson educational visits did not reduce antipsychotic polypharmacy in a Danish municipality, but the meetings were poorly attended (16).…”

Section: Strategies To Improve Quality Of Prescribingmentioning

confidence: 99%

Public-Academic Partnerships: A Program to Improve the Quality of Antipsychotic Prescribing in a Community Mental Health System

Brunette

Nesnera²,

Swain³

et al. 2011

Psychiatric Services

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State mental health authorities can use public-academic partnerships to create professional roles in which leaders can track trends, identify problems, and carry out quality improvement projects to address key issues. Leaders with positions in both academic institutions and state mental health authorities ensure access to resources, technical expertise, and key relationships to improve quality. The authors describe a public-academic partnership in New Hampshire and a quality improvement program it carried out. The program encourages providers at community mental health centers to adopt prescribing practices that limit the cardiometabolic side effects of antipsychotic medicines.

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Section: Strategies To Improve Quality Of Prescribingmentioning

confidence: 99%

Public-Academic Partnerships: A Program to Improve the Quality of Antipsychotic Prescribing in a Community Mental Health System

Brunette

Nesnera²,

Swain³

et al. 2011

Psychiatric Services

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“…Informationsprogramme und Fortbildungen für Ärzte und/oder Personal wirkten sich positiv auf die psychopharmakologische Versorgungspraxis aus (Avorn & Monane, 1992;Meador et al, 1997;Snowdon, 1999;Roberts et al, 2001;Eide & Schjot, 2001).…”

Section: Fortbildung Von äRzten Und/oder Pflegepersonalunclassified

Psychopharmakologische Behandlungspraxis in Münchener Altenpflegeheimen

Molter-Bock

Hasford

Pfundstein³

2006

Z Gerontol Geriatr

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“…One nonrandomised study evaluating the effect of a neuroleptic education programme for physicians and nurses in nursing homes found a 72% decrease in neuroleptic use following the intervention, compared with a 13% decrease in the non-intervention nursing homes (Ray et al, 1992). Other similar, but randomised interventions have resulted in neuroleptic use reductions of 18% (Avorn et al, 1992), 23% (Meador et al, 1997) and 50% (Rovner et al, 1996). Hence educational interventions in themselves are quite effective in reducing neuroleptic usage in nursing homes, although it is likely that such effects are less enduring than those resulting from legislative reforms, such as OBRA.…”

Section: Voluntary Efforts and The Role Of Educationmentioning

confidence: 99%

“…A reasonable conclusion that can be drawn from the existing literature is that more research and controlled trials are needed to demonstrate both the efficacy and long-term safety of these drugs in their use to treat nursing home residents. Furthermore, even residents who may turn out to be poor candidates for a total withdrawal of neuroleptics are probably good candidates for at least a reduction in dose (Meador et al, 1997).…”

Section: Consequences Of Withdrawing Neurolepticsmentioning

confidence: 99%

Neuroleptic drug use in long‐term care: An inappropriate panacea?

Hagen

Armstrong‐Esther²

2001

Quality in Ageing and Older Adults

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Despite the increasing evidence about the inappropriate use of medications by older people, there is very little published evidence about the control and monitoring of neuroleptic drugs used in nursing homes. As others have indicated, this is all the more worrying when set in the context of the paucity of research on nursing home care and the trend to replace registered nurses with untrained care assistants. In the United States, legislation in the form of the Nursing Home Reform Act (OBRA 1987) was introduced, in part, to regulate the prescribing and administration of neuroleptic (antipsychotic) drugs. No such legislation exists in Canada or the United Kingdom. In the case of the latter jurisdiction, the recent Royal Commission on Long-Term Care for older people (The Stationery Office, 1999) has recommended a national care commission to monitor care, and set assessment and quality benchmarks. In Canada this debate has not even begun, and the purpose of this paper is not to ignite controversy, but to raise questions about the use of these drugs with nursing home residents. Voluntary guidelines and education of physicians, nurses and care attendants would be infinitely better than legislation. In the meantime, we need research to address the following questions: For what reasons should these drugs be given to older people? Are these drugs being used appropriately? Is the risk of side-effects too great with these drugs? Are the numbers and type of staff employed in nursing homes adequate/qualified to detect and report side-effects? How well do these drugs manage the behaviours they are given lo control? Are they being used as chemical restraints or to make the older person compliant? Are the so-called 'atypical' neuroleptic drugs any better? What we offer in this article is background information that might encourage others to not only review their practice but also to address these questions.

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Predictors of Antipsychotic Withdrawal or Dose Reduction in a Randomized Controlled Trial of Provider Education

Cited by 59 publications

References 13 publications

Public-Academic Partnerships: A Program to Improve the Quality of Antipsychotic Prescribing in a Community Mental Health System

Public-Academic Partnerships: A Program to Improve the Quality of Antipsychotic Prescribing in a Community Mental Health System

Psychopharmakologische Behandlungspraxis in Münchener Altenpflegeheimen

Neuroleptic drug use in long‐term care: An inappropriate panacea?

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