The effect of biannual medication reviews on the appropriateness of psychotropic drug use for neuropsychiatric symptoms in patients with dementia: a randomised controlled trial

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

doi:10.1093/ageing/afy001

Cited by 39 publications

(50 citation statements)

References 26 publications

(42 reference statements)

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“…A recent randomised controlled trial demonstrated the potential for biannual, structured, multi-disciplinary medication reviews to improve appropriate prescribing of psychotropic medications in nursing home patients with dementia. 79 Although psychotropic medication reviews may occur in nursing homes, if implemented they are often performed in an ad-hoc manner without adequate resources and usually without multi-disciplinary input.…”

Section: Discussionmentioning

confidence: 99%

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

Jennings

Foley

Walsh

et al. 2018

Int J Geriat Psychiatry

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ObjectivesTo synthesise the existing published literature on general practitioners (GP)'s knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia (BPSD) with a view to informing future interventions.MethodsWe conducted a systematic review and synthesis of quantitative and qualitative studies that explored GPs' experiences of managing BPSD (PROSPERO protocol registration CRD42017054916). Seven electronic databases were searched from inception to October 2017. Each stage of the review process involved at least 2 authors working independently. The meta‐ethnographic approach was used to synthesise the findings of the included studies while preserving the context of the primary data. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to assess the confidence in our individual review findings.ResultsOf the 1638 articles identified, 76 full texts were reviewed and 11 were included. Three main concepts specific to GPs' experiences of managing BPSD emerged: unmet primary care resource needs, justification of antipsychotic prescribing, and the pivotal role of families. A “line of argument” was drawn, which described how in the context of resource limitations a therapeutic void was created. This resulted in GPs being over reliant on antipsychotics and family caregivers. These factors appeared to culminate in a reactive response to BPSD whereby behaviours and symptoms could escalate until a crisis point was reached.ConclusionThis systematic review offers new insights into GPs' perspectives on the management of BPSD and will help to inform the design and development of interventions to support GPs managing BPSD.

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Section: Discussionmentioning

confidence: 99%

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

Jennings

Foley

Walsh

et al. 2018

Int J Geriat Psychiatry

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“…This study emphasizes that psychotropic drugs are often prescribed in community-dwelling persons with youngonset dementia and that these drugs are also used for prolonged periods of time, which is not in line with current guidelines. Therefore, more attention must be paid to following the guidelines and frequently evaluating the use of psychotropic drugs and discontinuing their use whenever possible (van der Spek et al, 2018).…”

Section: Resultsmentioning

confidence: 99%

“…Indication, evaluation and therapy duration can be improved by introducing repeated medication reviews (Massot Mesquida et al, 2019;van der Spek et al, 2018). Perhaps this is also achievable for general practitioners in the treatment of young persons with dementia.…”

Section: Resultsmentioning

confidence: 99%

Psychotropic drug use in community-dwelling people with young-onset dementia: two-year course and determinants

Gerritsen¹,

Bakker²,

Bruls³

et al. 2019

Aging & Mental Health

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Objectives: The aim of this study was to describe the course of psychotropic drug use in people with young-onset dementia and to explore possible associations with age, sex, dementia severity, dementia subtype and neuropsychiatric symptoms. Methods: Psychotropic drug use was studied in 198 community-dwelling persons participating in the Needs in Young-onset Dementia study. Data about psychotropic drug use were retrieved at baseline, as well as at 6, 12, 18 and 24 months and was classified into five groups (antiepileptics, antipsychotics, anxiolytics, hypnotics/sedatives and antidepressants) and quantified as 'present' or 'absent'. Generalized Estimating Equation modeling and chi-square tests were used to study associations between the determinants and psychotropic drug use. Results: There was a statistically significant increase in the prevalence of psychotropic drug use from 52.3% to 62.6% during the course of the study. Almost three-quarters (72.4%) of the participants were treated with any psychotropic drug during the study, and more than one-third (37.4%) received psychotropic drugs continuously. Antipsychotics were used continuously in more than 10% of the participants and antidepressants in more than 25%. Increasing age was positively associated (p ¼ .018) with psychotropic drug use at baseline, while apathy symptoms were negatively associated (p ¼ .018). Conclusions: Despite the recommendations of various guidelines, the prolonged use of psychotropic drugs in community-dwelling people with young-onset dementia is high. Therefore, more attention is needed to timely evaluate psychotropic drug use and the introduction of self-management programs for caregivers should be encouraged to support caregivers in dealing with the neuropsychiatric symptoms caused by the dementia.

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“…Although neuroleptics were the drug class most commonly deprescribed in the present study, deprescription of any psychotropic drug was included, based on the patient’s response to treatment and current clinical status with regard to comorbidity, degree of dependence, and functionality. In a study by van der Spek [26], biannual medication review was applied to improve the appropriateness of the psychotropic drugs prescribed in nursing home patients with dementia. As the evaluation of the intervention differed from the one used here, the significant results obtained in improving the appropriateness of psychotropic drugs prescription cannot be compared with those of our study.…”

Section: Discussionmentioning

confidence: 99%

Consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients

et al. 2019

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BackgroundDementia patients often show neuropsychiatric symptoms, known as behavioral and psychological symptoms of dementia (BPSD). These are a common motive for medical consultations, hospitalizations, and nursing home stays. Various studies have suggested that the high prevalence of psychotropic drug use to treat BPSD in institutionalized dementia patients may lead to impaired cognitive capacity, rigidity, somnolence, and other complications during the course of the illness. The aim of this study was to design a consensus-based intervention between care levels to optimize and potentially reduce prescription of psychotropic drugs in institutionalized patients with dementia and assess the changes occurring following its implementation.MethodsDesign: Prospective, quasi-experimental, pre/post intervention, multicenter study. Scope: 7 nursing homes associated with a single primary care team. Inclusion Criteria: Institutionalized patients diagnosed with dementia and under treatment with 1 or more psychotropic drugs for at least 3 months. Sample: 240 individuals; mean age, 87 years (SD: 6.795); 75% (180) women. Intervention: Creation of evidence-based therapeutic guidelines for psychotropic drug use in the treatment of BPSD by consensus between reference professionals. Joint review (primary care and geriatric care nursing home professionals) of the medication based on the guidelines and focusing on individual patient needs. Primary variable: Number of psychotropic drugs used per patient. Assessment: Preintervention, immediate postintervention, and at 1 and 6 months.ResultsOverall, the number of psychotropic drugs prescribed was reduced by 28% (from 636 before to 458 after the intervention). The mean number of psychotropic drugs prescribed per patient decreased from 2.71 at baseline to 1.95 at 1 month postintervention and 2.01 at 6 months (p < 0.001 for both time points). Antipsychotics were the drug class showing the highest reduction rate (49.66%). Reintroduction of discontinued psychotropic drugs was 2% at 1 month following the intervention and 12% at 6 months.ConclusionsA consensus guidelines-based therapeutic intervention with a patient-centered medication review by a multidisciplinary team led to a reduction in prescription of psychotropic drugs in institutionalized dementia patients.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-1015-9) contains supplementary material, which is available to authorized users.

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The effect of biannual medication reviews on the appropriateness of psychotropic drug use for neuropsychiatric symptoms in patients with dementia: a randomised controlled trial

Cited by 39 publications

References 26 publications

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

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

Psychotropic drug use in community-dwelling people with young-onset dementia: two-year course and determinants

Consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients

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