scholarly journals Reducing inappropriate psychotropic drug use in nursing home residents with dementia: protocol for participatory action research in a stepped-wedge cluster randomized trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Claudia M. Groot Kormelinck ◽  
Charlotte F. van Teunenbroek ◽  
Boudewijn J. Kollen ◽  
Margreet Reitsma ◽  
Debby L. Gerritsen ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Nursing Homes ◽  
Participatory Action Research ◽  
Psychotropic Drug ◽  
Neuropsychiatric Symptoms ◽  
Nursing Home Residents ◽  
Drug Prescribing ◽  
Tailored Intervention ◽  
Participatory Action

Abstract Background Psychotropic drugs are often prescribed to treat neuropsychiatric symptoms in nursing home residents with dementia, despite having limited efficacy and considerable side effects. To reduce the inappropriate prescribing of these psychotropic drugs, various non-pharmacological, psychosocial, person-centered, or multidisciplinary interventions are advocated. However, existing multidisciplinary interventions have shown variable effects, with limited effectiveness often resulting from suboptimal implementation. We hypothesize that an effective intervention needs to fit the local situation of a nursing home and that support should be offered during implementation. Methods We will embed participatory action research within a stepped-wedge cluster randomized controlled trial to study the effects of a tailored intervention and implementation plan to reduce inappropriate psychotropic drug prescribing. Nursing homes will be provided with tailored information about the perceived problems of managing neuropsychiatric symptoms and we will offer coaching support throughout. Alongside the participatory action research, we will perform a process evaluation to examine the quality of the study, the intervention, and the implementation. Our aim is to recruit 600 residents from 16 nursing homes throughout the Netherlands, with measurements taken at baseline, 8 months, and 16 months. Nursing homes will be randomly allocated to an intervention or a deferred intervention group. During each intervention stage, we will provide information about inappropriate psychotropic drug prescribing, neuropsychiatric symptoms, and difficulties in managing neuropsychiatric symptoms through collaboration with each nursing home. After this, a tailored intervention and implementation plan will be written and implemented, guided by a coach. The primary outcome will be the reduction of inappropriate prescribing, as measured by the Appropriate Psychotropic drug use In Dementia index. Secondary outcomes will be the frequency of psychotropic drug use and neuropsychiatric symptoms, plus quality of life. A mixed methods design will be used for the process evaluation. Effects will be assessed using multilevel analyses. The project leader of the nursing home and the coach will complete questionnaires and in-depth interviews. Discussion We anticipate that the proposed tailored intervention with coaching will reduce inappropriate psychotropic drug prescribing for nursing home residents with neuropsychiatric symptoms. This study should also provide insights into the barriers to, and facilitators of, implementation. Trial registration NTR5872, registered on July 2, 2016.

scholarly journals Process evaluation of a tailored intervention to Reduce Inappropriate psychotropic Drug use in nursing home residents with dementia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Claudia M. Groot Kormelinck ◽  
Charlotte F. van Teunenbroek ◽  
Sytse U. Zuidema ◽  
Martin Smalbrugge ◽  
Debby L. Gerritsen
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Nursing Homes ◽  
Process Evaluation ◽  
Psychotropic Drug ◽  
Readiness To Change ◽  
Nursing Home Residents ◽  
Barriers And Facilitators ◽  
Psychotropic Drug Use ◽  
Barriers To Implementation

Abstract Background Research suggests that collaborative and tailored approaches with external expertise are important to process implementations. We therefore performed a process evaluation of an intervention using participatory action research, tailored information provision, and external coaching to reduce inappropriate psychotropic drug use among nursing home residents with dementia. The process evaluation was conducted alongside a randomized controlled trial assessing the utility of this approach. Methods We used Leontjevas’ model of process evaluation to guide data collection and analysis, focusing on the relevance and feasibility, extent of performance, and barriers and facilitators to implementation. Data on the relevance and feasibility and on the extent of performance were collected using a questionnaire targeting internal project leaders at nursing homes and our external coaches. Implementation barriers and facilitators were identified by individual semi-structured interviews. The Consolidated Framework for Implementation Research was used to structure and describe the identified barriers and facilitators. Results The intervention was viewed positively, but it was also considered time consuming due to the involvement of many people and designing a tailored action and implementation plan was viewed as complex. The extent of performance differed between nursing homes. Delays in implementation and suboptimal execution of actions may have reduced effectiveness of the RID intervention in some nursing homes. Barriers to implementation were reorganizations, staff turnover, communication issues, unclear expectations, and perceived time pressures. Implementation also depended on the involvement and skills of key stakeholders, and organizations’ readiness to change. Although external coaches stimulated implementation, their additional value was rated variably across organizations. Conclusions Barriers to implementation occurred on several levels and some barriers appear to be inherent to the nursing home environment and could be points of leverage of future implementation trajectories. This underlines the importance of assessing and supporting organizations in their readiness to change. Sensitivity analyses, taking into account the week in which nursing homes started with implementation and the degree to which actions were implemented as intended, will be appropriate in the effect analyses of the trial.

scholarly journals Assessment of Psychotropic Drug Prescribing Among Nursing Home Residents in Ontario, Canada, During the COVID-19 Pandemic

2021 ◽  
Author(s):  
Nathan M. Stall ◽  
Jonathan S. Zipursky ◽  
Jagadish Rangrej ◽  
Aaron Jones ◽  
Andrew P. Costa ◽  
...  
Keyword(s):  
Nursing Home ◽  
Psychotropic Drug ◽  
Nursing Home Residents ◽  
Drug Prescribing

Longitudinal Study of Psychotropic Drug Use by Elderly Nursing Home Residents

1992 ◽  
Vol 47 (6) ◽  
pp. M183-M188 ◽  
Author(s):  
J. Garrard ◽  
T. Dunham ◽  
L. Makris ◽  
S. Cooper ◽  
L. L. Heston ◽  
...  
Keyword(s):  
Nursing Home ◽  
Longitudinal Study ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Nursing Home Residents ◽  
Psychotropic Drug Use

Prescribing pattern of psychotropic drugs in nursing home residents with dementia

2011 ◽  
Vol 23 (8) ◽  
pp. 1249-1259 ◽  
Author(s):  
R. B. Wetzels ◽  
S. U. Zuidema ◽  
J. F. M. de Jonghe ◽  
F. R. J. Verhey ◽  
R. T. C. M. Koopmans
Keyword(s):  
Nursing Home ◽  
Psychotropic Drug ◽  
Anatomical Therapeutic Chemical ◽  
Neuropsychiatric Symptoms ◽  
Nursing Home Residents ◽  
Severe Dementia ◽  
Prescribing Pattern ◽  
Antidementia Drugs ◽  
Utilization Patterns ◽  
To Receive

ABSTRACTBackground: The goal of this study is to determine patterns of psychotropic drug use (PDU), the association with neuropsychiatric symptoms (NPS), and the variability across dementia types in nursing home residents with dementia. In addition, PDU was analyzed across multiple indications.Methods: This was a prospective cohort study over a two-year period from 2006 to 2008, which involved 14 dementia special care units in nine nursing homes. A total of 117 residents with dementia participated in the study, of whom 35% had Alzheimer's dementia (AD) and 11% vascular dementia (VaD). PDU was classified according to anatomical therapeutic chemical-classification as either “present” or “absent”.Results: The majority of residents had moderately severe to severe dementia. At all successive assessments, almost two-thirds of residents received any psychotropic drug (PD) and almost one-third continued to receive any PD. Of all PDs, antipsychotics (APs) were prescribed most frequently. Fewer residents started with antidepressants, but continued to receive antidepressants at higher percentages. Anxiolytics showed an intermittent course, but a subgroup of 9% showed two-year continuation. Once started on PDs at baseline, residents continued to use PDs at high percentages: three-quarters continued to receive APs for at least six months. Half of residents received at least one PD; one-fifth received at least two PDs simultaneously. Residents with AD received more hypnotics and antidementia drugs; residents with VaD received more antipsychotics, antidepressants, anxiolytics and anticonvulsants.Conclusions: PDs have different utilization patterns, but overall, consistently high continuation rates were found. These results warrant scrutiny of continuous PDU.

scholarly journals The Prevalence of and Documented Indications for Antipsychotic Prescribing in Irish Nursing Homes

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 160
Author(s):  
Jayne E. Kelleher ◽  
Peter Weedle ◽  
Maria D. Donovan
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Antipsychotic Medication ◽  
Psychological Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Medication Use ◽  
Nursing Home Residents ◽  
Cross Sectional ◽  
Home Setting ◽  
Antipsychotic Prescribing

Background: Antipsychotic medications are often used ‘off-licence’ to treat neuropsychiatric symptoms and disorders of aging and to manage behavioural and psychological symptoms of dementia despite the warnings of adverse effects. Objective: To establish the prevalence of and documented indication for antipsychotic medication use in the Irish nursing home setting. Setting: This study was conducted in six nursing homes located in Co. Cork, Ireland. Method: A retrospective, cross-sectional study was employed. All patients who met the inclusion criteria (≥65 years, residing in a nursing home on a long-term basis) were eligible for inclusion. There were 120 nursing home residents recruited to the study. Main Outcome Measure: The prevalence of antipsychotic medication use in nursing home residents (with and without dementia). Results: The overall prevalence of antipsychotic prescribing was found to be 48% and patients with dementia were significantly more likely to be prescribed an antipsychotic compared to those without dementia (67% vs. 25%) (χ2 (1, N = 120) = 21.541, p < 0.001). In the cohort of patients with dementia, there was a trend approaching significance (p = 0.052) of decreasing antipsychotic use with increasing age (age 65–74 = 90%; age 75–84 = 71%; age 85 and over = 58%). An indication was documented for 84% of the antipsychotic prescriptions in this cohort. Conclusion: The findings of this study highlight that high rates of antipsychotic medication use remains an issue in Irish nursing homes. Further work should explore factors in influencing prescribing of these medications in such settings.

scholarly journals Can the PROPER intervention reduce psychotropic drug prescription in nursing home residents with dementia? Results of a cluster-randomized controlled trial

2020 ◽  
pp. 1-10
Author(s):  
C.H.W. Smeets ◽  
M. Smalbrugge ◽  
R.T.C.M. Koopmans ◽  
M.H.J.M.G. Nelissen-Vrancken ◽  
K. van der Spek ◽  
...  
Keyword(s):  
Nursing Home ◽  
The Netherlands ◽  
Psychotropic Drug ◽  
Psychotropic Drugs ◽  
Neuropsychiatric Symptoms ◽  
Nursing Home Residents ◽  
Term Care ◽  
Randomized Controlled ◽  
Percentage Points ◽  
Cluster Randomized

ABSTRACT Objectives: To evaluate the effect of the PROPER intervention in nursing home residents with dementia on the prevalence of psychotropic drug use and neuropsychiatric symptoms. Design: A cluster-randomized controlled design with two parallel groups (intervention versus usual care) and assessments at 0, 6, 12, and 18 months. Setting: Thirty-one dementia special care units within 13 long-term care organizations in the Netherlands. Participants: Three hundred eighty nursing home residents with dementia Intervention: The PROPER intervention consisted of a structured and repeated multidisciplinary medication review, supported by education and continuous evaluation. Measurements: Prescriptions of antipsychotics, antidepressants, anxiolytics, and hypnotics, and occurrence of neuropsychiatric symptoms. Results: The prescription of any type of psychotropic drugs increased in the intervention group, and decreased in the control group, with an estimated difference of 3.9 percentage points per 6 months (p = 0.01). Effects for the individual drug groups were minor (differences of 1.6 percentage points and below per 6 months) and not statistically significant. The occurrence of neuropsychiatric symptoms remained stable in both the intervention and control groups during the follow-up of 18 months. Conclusions: The PROPER intervention failed to demonstrate effectiveness in reducing the prevalence of psychotropic drugs. It may be interesting to enrich the intervention with components that address personal attitudes and communication between nursing home professionals, not only with respect to the prescription of psychotropic drugs, but also to neuropsychiatric symptoms. The study has been registered in The Netherlands Trial Register (NTR3569).

Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study

2016 ◽  
Vol 28 (10) ◽  
pp. 1589-1595 ◽  
Author(s):  
Klaas van der Spek ◽  
Debby L. Gerritsen ◽  
Martin Smalbrugge ◽  
Marjorie H. J. M. G. Nelissen-Vrancken ◽  
Roland B. Wetzels ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Neuropsychiatric Symptoms ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Inappropriate Use ◽  
Psychotropic Drug Use ◽  
Nursing Home Patients ◽  
Sum Score

ABSTRACTBackground:This study explores the appropriateness of psychotropic drug (PD) use for neuropsychiatric symptoms (NPS) in nursing home patients with dementia.Methods:A cross-sectional study on 559 patients with dementia residing on dementia special care units in Dutch nursing homes was conducted. Appropriateness of PD use was assessed using the Appropriate Psychotropic drug use In Dementia (APID) index. The APID index score is calculated using information about individual PDs from patients’ medical records. The index encompasses seven (different) domains of appropriateness, i.e. indication, evaluation, dosage, drug-drug interactions, drug-disease interactions, duplications, and therapy duration.Results:A total of 578 PDs were used for NPS by 60% of the nursing home patients. Indication, evaluation, and therapy duration contributed the most to inappropriate use. Ten per cent of the PDs scored fully appropriate according to the APID index sum score, 36% scored fully appropriate for indication, 46% scored fully appropriate for evaluation, and 58% scored fully appropriate for therapy duration. Antidepressants were used the most appropriately, and antiepileptics the most inappropriately.Conclusions:The minority of the PD use was fully appropriate. The results imply that PD use for NPS in dementia can be improved; the appropriateness should be optimized with a clinical focus on the appropriate indications, evaluations, and therapy duration.

Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians’ prescription behavior

2011 ◽  
Vol 23 (10) ◽  
pp. 1632-1639 ◽  
Author(s):  
Sytse U. Zuidema ◽  
Jos F. M. de Jonghe ◽  
Frans R. J. Verhey ◽  
Raymond T. C. M. Koopmans
Keyword(s):  
Nursing Home ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Home Environment ◽  
Neuropsychiatric Symptoms ◽  
Living Room ◽  
Environmental Correlates ◽  
Nursing Home Patients ◽  
Number Of Patients ◽  
Antidepressant Use

ABSTRACTBackground: The aim of the study was to examine whether staff distress and aspects of the nursing home environment were associated with psychotropic drug use (PDU) in patients with dementia.Methods: This was a cross-sectional study of 1289 nursing home patients with dementia from 56 Dementia Special Care Units (SCUs) in the Netherlands. The primary outcome was PDU. Potential correlates of PDU were staff distress, environmental correlates (the number of patients per unit or per living room, staff/patient ratio, and the presence of a walking circuit), and patient factors (gender, age, dementia severity, and neuropsychiatric symptoms (NPS)). Multilevel logistic regression analysis was used to estimate the relative contributions of predictor variables in explaining PDU.Results: Staff distress, aspects of the physical nursing home environment and patients’ neuropsychiatric symptoms were independently associated with PDU. Staff distress at patients’ agitation was associated with antipsychotic and anxiolytic drug use (OR 1.66, 95% CI (1.16–2.36) and 1.62 (1.00–2.61), respectively). SCUs with more patients per living room had higher hypnotic drug use (OR 1.08, 95% CI (1.02–1.14)). Low staff/patient ratio was associated with high antidepressant drug use (OR 0.13, 95% CI (0.04–0.47)). The effects of nursing home environment on study outcome were smallest for antidepressant use (intra-SCU correlation 0.005) and highest for hypnotic use (intra-SCU correlation 0.171).Conclusion: Staff distress and other environmental aspects are independently associated with PDU. These findings raise questions about the appropriateness of psychoactive drug prescriptions for nursing home patients with dementia.

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