Prescribing of psychotropic medication for nursing home residents with dementia: a general practitioner survey

Abstract

ObjectiveThe aim of this study was to identify factors influencing the prescribing of psychotropic medication by general practitioners (GPs) to nursing home residents with dementia.Subjects and methodsGPs with experience in nursing homes were recruited through professional body newsletter advertising, while 1,000 randomly selected GPs from southeastern Australia were invited to participate, along with a targeted group of GPs in Tasmania. An anonymous survey was used to collect GPs’ opinions.ResultsA lack of nursing staff and resources was cited as the major barrier to GPs recommending non-pharmacological techniques for behavioral and psychological symptoms of dementia (BPSD; cited by 55%; 78/141), and increasing staff levels at the nursing home ranked as the most important factor to reduce the usage of psychotropic agents (cited by 60%; 76/126).ConclusionAccording to GPs, strategies to reduce the reliance on psychotropic medication by nursing home residents should be directed toward improved staffing and resources at the facilities.

General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed‐methods systematic review

“…However, in some of the studies, participating GPs demonstrated a good knowledge of both non‐pharmacological and pharmacological management options in BPSD . For example, in one study, most GPs reported proactively reducing psychotropic medications and routinely recommending non‐pharmacological interventions prior to commencing medications; however, these GPs still felt they required “more training” in BPSD.…”

“…In 4 studies, the prescribing of antipsychotics was seen to enable carers, nursing home staff, and the person with dementia to cope with BPSD: “ he was weeping for his wife who has been dead for many years … on quetiapine … the uncontrollable weeping had stopped. ” Although in some studies GPs were aware of the risks of antipsychotic prescribing in people with dementia, these risks were seen to relate to longevity of life whereas in BPSD “quality of life issues prevailed.” In several studies, GPs' believed antipsychotics positively impacted on the quality of life of people with BPSD . This contributed to their reluctance to discontinue antipsychotics .…”

“…” Although in some studies GPs were aware of the risks of antipsychotic prescribing in people with dementia, these risks were seen to relate to longevity of life whereas in BPSD “quality of life issues prevailed.” In several studies, GPs' believed antipsychotics positively impacted on the quality of life of people with BPSD . This contributed to their reluctance to discontinue antipsychotics . Additionally, in 2 studies, GPs expressed a concern that discontinuing the antipsychotic would lead to a “return of challenging behaviours.”…”

“…This contributed to their reluctance to discontinue antipsychotics . Additionally, in 2 studies, GPs expressed a concern that discontinuing the antipsychotic would lead to a “return of challenging behaviours.”…”

“…Several studies considered the challenges inherent to implementing non‐pharmacological strategies in BPSD . A key finding in 3 of the studies that were conducted in nursing home settings related to the influence of nursing home staff on the implementation of non‐pharmacological strategies . Pressure from staff to prescribe medication influenced the GPs' management decisions and acted as a barrier to recommending non‐pharmacological strategies: “ often it is pressure from nursing homes … for medication to calm a patient down that is trigger for prescribing.…”