scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medications use among residents with dementia in Australian rural aged care homes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Qualitative Data ◽  
Psychiatric Symptoms ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention ◽  
Post Intervention ◽  
Rural Nursing ◽  
Limited Effectiveness

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n = 31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up. Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n = 27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medications, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration ANZCTR, ACTRN12618000263291. Registered on 20th February 2018.

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

2021 ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Psychotropic Medication ◽  
Qualitative Data ◽  
Medication Use ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention ◽  
Post Intervention ◽  
Rural Nursing

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n=31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n=27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medication, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

2020 ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Psychotropic Medication ◽  
Medication Use ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention ◽  
Post Intervention ◽  
Rural Nursing ◽  
Limited Effectiveness

Abstract BackgroundHigh rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with advanced dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold (PLST) and person-centered music intervention.MethodsOur larger study was a quasi-experimental design conducted in five rural nursing homes in Queensland and South Australia. Medication charts (n = 31) were collected retrospectively from three Australian rural aged care facilities through contacting the facility managers before the intervention and after 6 months. Fifty-three staff participated in 31 semi-structured interviews and 8 focus group at post-intervention, and at 1-month and 3-months follow up.ResultsThe median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% in the use of at least any psychotropic medication, 19.6% reduction in antipsychotics and benzodiazepines, and 6.5% reduction in antidementia medicines prescription from baseline to at post-intervention, however, these were not statistically significant. There was a decreasing trend in the use of inappropriate use of medications. Psychotropic medications were prescribed up to 43% and antidementia in 45% of participants for more than 6 months. Major themes extracted from qualitative data were reduced/decreased/cessation of medication use, introducing a rest period and the music intervention combined was an alternative approach for medications use, and less behaviors, and ultimately the less use of medications.ConclusionsOur findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications and inappropriate medications in rural nursing homes as supported by findings from both quantitative and qualitative data.Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with advanced dementia in Australian rural aged care homes

2020 ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Psychotropic Medication ◽  
Qualitative Data ◽  
Medication Use ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Advanced Dementia ◽  
Music Intervention ◽  
Post Intervention ◽  
Rural Nursing

Abstract BackgroundHigh rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with advanced dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. MethodsOur larger study was a quasi-experimental design conducted in five rural nursing homes in Queensland and South Australia. Medication charts (n=31) were collected retrospectively from three Australian rural aged care facilities through contacting the facility managers. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.ResultsThe median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n=27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medication, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (, 39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention However, these changes were not statistically significant, Additionally, there was a decreasing trend in the use of inappropriate use of medications. Psychotropic medications were prescribed in up to 43% and antidementia in 45% of participants for more than 6 months. Major themes extracted from qualitative data were reduced/decreased/cessation of medication use; introducing a rest period and the music intervention combination was an alternative approach for medications use, and resulting in less behaviors, and ultimately the less use of medications. ConclusionsOur findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications and inappropriate medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

scholarly journals Correction to: Person-centered, non-pharmacological intervention in reducing psychotropic medications use among residents with dementia in Australian rural aged care homes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals The Nexus of ‘Music, Mind, and Well-being’: Effects of Harmony in the Bush Music Intervention for Residents with Advanced Dementia in Australian Rural Nursing Homes

2020 ◽  
Author(s):  
Mohammad Hamiduzzaman ◽  
Abraham Kuot ◽  
Jennene Greenhill ◽  
Edward Strivens ◽  
Daya Ram Parajuli ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Qualitative Data ◽  
Psychiatric Symptoms ◽  
Behavioural Change ◽  
Well Being ◽  
T Test ◽  
Advanced Dementia ◽  
Music Intervention ◽  
Time Points ◽  
Rural Nursing

Abstract BackgroundPersons with dementia often show aggression, depression, and anxiety and these symptoms and behaviours escalate overtime without treatment. Music has been found to be useful for managing these symptoms and behaviours and can significantly improve well-being. This paper reports the effect of music on residents with advanced dementia in rural nursing homes, as a key part of the Harmony in the Bush study.MethodsWe conducted a quasi-experimental research in five Australian rural nursing homes. Managers of nursing homes were contacted to select residents with advanced dementia, resulted in 74 residents who participated in person-centred music and culturally-appropriate group music sessions. Staff (104) and musicians (6) participated in 65 interviews and 20 focus groups. One-Way ANOVA and paired-samples t-test were performed to understand Music in Dementia Assessment Scale (MiDAS) scores. Qualitative data were thematically analysed.ResultsSeventy-four residents participated in an average of 9.5 [SD 4.73] person-centred music sessions and most of them were female (n = 52/70%). Analysis revealed the overall mean effect of the person-centred music at two-time points as 67% [during-70% {351.22 (SD:93.51)}; and after-63% {315.09 (SD:98.52)}]. The residents with (moderate to severe) pain, anxiety, sadness, and agitation at pre-intervention, presented an improvement in their levels of interest, response, initiation, involvement, and enjoyment at different time-points. The t-test showed that the MiDAS sub-categories’ mean scores differed significantly between the time-points: interest [t = 2.75, p = 0.001]; response [t = 2.94, p = 0.005]; initiation [t = 2.41, p = 0.019]; and involvement [t = 2.78, p = 0.007]. Additionally, the residents were observed at post-intervention with a reduction of agitation (87.5%), low in mood (87.5%), and anxiousness (70.3%); and an improvement in relaxation (75.5%), attentiveness (56.5%), and smiling (56.9%). Themes from qualitative data were behavioural change, meaningful interaction, being initiative, increased participation, and contentment.ConclusionFindings suggest the music intervention probably reduce the residents’ psychiatric symptoms and behaviours and improve well-being.Clinical RegistrationThe study is registered with the Australian and New Zealand Clinical. Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p; http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

scholarly journals The Outcomes of a Person-centered, Non-Pharmacological Intervention in Reducing Behavioral and Psychiatric Symptoms in Residents With Advanced Dementia in Australian Rural Nursing Homes

2020 ◽  
Author(s):  
Vivian Isaac ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Edward Strivens ◽  
Jennene Greenhill
Keyword(s):  
Nursing Homes ◽  
Psychiatric Symptoms ◽  
Trial Registration ◽  
Advanced Dementia ◽  
Aggressive Behaviors ◽  
Rural Nursing ◽  
Stress Threshold ◽  
Progressively Lowered Stress Threshold ◽  
Stress Inventory ◽  
Rural Australia

Abstract BackgroundThere is limited best- practice evidence to address behavioral and psychiatric symptoms for those with advanced dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia.MethodsA quasi-experimental study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with advanced dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focusing on the theory and delivery of the Progressively Lowered Stress Threshold principles and a music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. Triangulation using post- intervention qualitative evaluation from 13 focus group discussion and 38 staff interviews. This study adheres to the CONSORT guidelines.ResultsMean age of residents with advanced dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was comparable reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency.ConclusionsThe Harmony in the Bush model is effective in reducing behavioral and psychiatric symptoms in advanced dementia with significant reduction in staff stress levels in nursing homes in rural Australia.Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458

scholarly journals The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vivian Isaac ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Edward Strivens ◽  
Jennene Greenhill
Keyword(s):  
Nursing Homes ◽  
Intervention Study ◽  
Trial Registration ◽  
Pharmacological Intervention ◽  
Aggressive Behaviors ◽  
Rural Nursing ◽  
Stress Threshold ◽  
Progressively Lowered Stress Threshold ◽  
Stress Inventory ◽  
Rural Australia

Abstract Background There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia. Methods A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines. Results Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency. Conclusions The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia. Trial registration Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458

Physicians’ practice and familiarity with treatment for agitation associated with dementia in Israeli nursing homes

2012 ◽  
Vol 25 (2) ◽  
pp. 236-244 ◽  
Author(s):  
Jiska Cohen-Mansfield ◽  
Atarah Juravel-Jaffe ◽  
Aaron Cohen ◽  
Iris Rasooly ◽  
Hava Golander
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Pharmacological Treatment ◽  
Psychotropic Medications ◽  
Actual Practice ◽  
Pharmacological Intervention ◽  
Personal Interview ◽  
Pharmacological Interventions ◽  
The Relationship ◽  
Current Guidelines

ABSTRACTBackground: To clarify physicians’ actual practice in treating agitation in the nursing home and to elucidate the relationship between background factors, familiarity with interventions, and practice.Methods: A survey of actual practice for agitation in persons with dementia was administered to 67 physicians aged 31–70+ working in nursing homes in Israel. Questionnaires were administered by personal interview, self-completed, or a combination of the two.Results: Psychotropic medications are prescribed by 92.5% of physicians for treating agitation, most notably, Haloperidol (39%). Non-pharmacological treatment was also reported to be common, though to a lesser extent, with environmental change being the most prevalent non-pharmacological intervention. Generally, physicians showed low familiarity levels with non-pharmacological interventions, with higher levels noted for physicians with a specialty in geriatrics compared to those who were non-specialized. Physicians who were non-Israeli and younger also reported higher familiarity levels compared to their respective counterparts (i.e. Israeli and older) but this difference did not reach significance.Conclusion: The findings indicate that, despite current guidelines, psychotropic medications are the treatment of choice among nursing home physicians in Israel. While rates of use of non-pharmacological interventions are substantial, their in-practice application may be hindered by lack of familiarity as well as system barriers. The results have implications for system and education changes.

scholarly journals The outcomes of a person-centered, non-pharmacological intervention in reducing agitation in residents with dementia in Australian rural nursing homes

2020 ◽  
Author(s):  
Vivian Isaac ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Edward Strivens ◽  
Jennene Greenhill
Keyword(s):  
Nursing Homes ◽  
Intervention Study ◽  
Trial Registration ◽  
Pharmacological Intervention ◽  
Aggressive Behaviors ◽  
Rural Nursing ◽  
Stress Threshold ◽  
Progressively Lowered Stress Threshold ◽  
Stress Inventory ◽  
Rural Australia

Abstract BackgroundThere is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia.MethodsA quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines.ResultsMean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency.ConclusionsThe Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia.Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458

GPs’ experience of safeguarding in care homes: what do they see and what do they do?

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711269
Author(s):  
Elisabeth Alton ◽  
Caroline White
Keyword(s):  
Online Survey ◽  
Qualitative Data ◽  
Care Home ◽  
Health Needs ◽  
Care Homes ◽  
Electronic Records ◽  
Multiple Relationships ◽  
Home Context ◽  
Emerging Themes ◽  
Multiple Health

BackgroundAbuse of older people in care homes is an on-going problem. GPs, as the most frequent practitioner group visiting care homes, have an important role in detecting and reporting abuse. However, there is little research about GPs’ experiences of working in care homes and how they work to safeguard residents.AimTo explore the challenges experienced by GPs working in this unique environment and how these impact on safeguarding.MethodAn online survey collected qualitative data about GPs’ experiences as visiting professionals to care homes, with an emphasis on safeguarding. A thematic analysis identified key themes.ResultsIn total, 58 completed surveys were returned, with a range of practitioner experience represented (1–30 years). Approximately 70% were GP partners, with the remainder salaried and locum doctors. Over one third reported they had witnessed signs of definite or possible abuse within care homes. Emerging themes related to the complex care home context, in which residents had multiple health needs and GPs had to build multiple relationships with managers, carers, families, and residents. Difficulties in accessing information were reported; residents could not always provide information, GPs had to rely on others for information, and rarely had access to electronic records.ConclusionGP work in care homes is a complex and skilled role, in which GPs encounter evidence of poor care and abuse. Key themes in respect of barriers and facilitators of good care were highlighted. The reliance on others for information and the need to build relationships with staff/managers may raise tensions in respect of safeguarding practice.

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