scholarly journals Developing a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia

2021 ◽  
Vol 4 ◽  
pp. 23
Author(s):  
Kieran A. Walsh ◽  
Stephen Byrne ◽  
Jenny Mc Sharry ◽  
John Browne ◽  
Kate Irving ◽  
...  
Keyword(s):  
Nursing Home ◽  
Complex Intervention ◽  
Development Process ◽  
Assessment Tool ◽  
Evidence Synthesis ◽  
Complex Interventions ◽  
Nursing Home Residents ◽  
Intervention Development ◽  
Qualitative Evidence Synthesis ◽  
Antipsychotic Prescribing

Background: Antipsychotics are commonly prescribed to people living with dementia in nursing home settings, despite strong guideline recommendations against their use except in limited circumstances. We aimed to transparently describe the development process for a complex intervention targeting appropriate requesting and prescribing of antipsychotics to nursing home residents with dementia in Ireland, by nurses and general practitioners (GPs) respectively. Methods: We report the development process for the ‘Rationalising Antipsychotic Prescribing in Dementia’ (RAPID) complex intervention, in accordance with the ‘Guidance for reporting intervention development studies in health research’ (GUIDED) checklist.  The UK Medical Research Council framework for developing and evaluating complex interventions guided our overall approach, incorporating evidence and theory into the intervention development process. To unpack the intervention development process in greater detail, we followed the Behaviour Change Wheel approach. Guided by our stakeholders, we conducted three sequential studies (systematic review and qualitative evidence synthesis, primary qualitative study and expert consensus study), to inform the intervention development. Results: The RAPID complex intervention was developed in collaboration with a broad range of stakeholders, including people living with dementia and family carers, between 2015 and 2017. The finalised RAPID complex intervention was comprised of the following three components; 1) Education and training sessions with nursing home staff; 2) Academic detailing with GPs; 3) Introduction of an assessment tool to the nursing home. Conclusions: This paper describes the steps used by the researchers to develop a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia in Ireland, according to the GUIDED checklist. We found that the GUIDED checklist provided a useful way of reporting all elements in a cohesive manner and complemented the other tools and frameworks used. Transparency in the intervention development processes can help in the translation of evidence into practice.

Identifying behavior change techniques for inclusion in a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia

2020 ◽  
Author(s):  
Kieran A Walsh ◽  
Suzanne Timmons ◽  
Stephen Byrne ◽  
John Browne ◽  
Jenny Mc Sharry
Keyword(s):  
Nursing Home ◽  
Behavior Change ◽  
Complex Intervention ◽  
Mode Of Delivery ◽  
Nursing Home Residents ◽  
Intervention Development ◽  
Behavior Change Techniques ◽  
People With Dementia ◽  
Increased Risk ◽  
Antipsychotic Prescribing

Abstract Nursing home residents with dementia are commonly prescribed antipsychotics despite the associated increased risk of harms. Interventions to optimize prescribing practice have been found to be effective in the short term, but there is a lack of evidence to support sustainability of effects, along with a lack of theory, public involvement, and transparency in the intervention development process. Using theory has been advocated as a means of improving intervention sustainability. The aim of this study was, therefore, to identify behavior change techniques (BCTs) for inclusion in a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia. A comprehensive approach to identifying a long list of all potential BCTs from three different sources was undertaken. The most appropriate BCTs were then selected through a two-round Delphi consensus survey with a broad range of experts (n = 18 panelists). Advisory groups of people with dementia, family carers, and professional stakeholders provided feedback on the final BCTs included. After two Delphi survey rounds, agreement was reached on 22 BCTs. Further refinement of the selected BCTs based on advisory group and panelists’ feedback, along with use of the APEASE criteria (Affordability, Practicability, Effectiveness, Acceptability, Side effects/safety, and Equity) resulted in a final list of 16 BCTs. The next step in intervention development will be to identify the most appropriate mode of delivery of the 16 BCTs identified for inclusion. The study provides a case example of a systematic approach to incorporating evidence with stakeholder views in the identification of appropriate BCTs.

scholarly journals Barriers and enablers to monitoring and deprescribing opioid analgesics for chronic non-cancer pain: protocol for a qualitative evidence synthesis using the Theoretical Domains Framework

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e034039
Author(s):  
Amanda J Cross ◽  
Rachelle Buchbinder ◽  
Allison Bourne ◽  
Christopher Maher ◽  
Stephanie Mathieson ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Cancer Pain ◽  
Assessment Tool ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Theoretical Domains Framework ◽  
Opioid Analgesics ◽  
Qualitative Evidence Synthesis ◽  
Barriers And Enablers ◽  
Qualitative Evidence

IntroductionThe over-prescription and overuse of opioid analgesics for chronic non-cancer pain (CNCP) is a growing issue. Synthesis of evidence about the barriers and enablers to reducing long-term opioid prescribing and use will enable the development of tailored interventions to address both problems.ObjectiveTo synthesise the barriers and enablers to monitoring the ongoing appropriateness of opioid treatment and deprescribing opioids for CNCP from the clinician, patient and general public point of view, and to map the findings to the Theoretical Domains Framework (TDF).Methods and analysisWe will perform a qualitative evidence synthesis using the TDF. We will include qualitative research that has explored clinician, patient and the general public’s perceptions regarding barriers and enablers to monitoring and deprescribing opioids for CNCP. Studies will be identified via searches in MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. Databases will be searched from inception to July 2019, and the studies must be published in English. Article selection and data extraction will be completed independently by two review authors. Methodological quality of included studies will be independently assessed by two review authors using the Critical Appraisal Skills Programme quality assessment tool. We will conduct thematic synthesis and then map identified themes and sub-themes to TDF domains. Confidence in synthesis findings will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research tool.Ethics and disseminationEthical approval is not required to conduct this review. We will publish the results in a peer-reviewed journal.PROSPERO registration numberCRD42019140784

scholarly journals Qualitative evidence synthesis for complex interventions and guideline development: clarification of the purpose, designs and relevant methods

2019 ◽  
Vol 4 (Suppl 1) ◽  
pp. e000882 ◽  
Author(s):  
Kate Flemming ◽  
Andrew Booth ◽  
Ruth Garside ◽  
Özge Tunçalp ◽  
Jane Noyes
Keyword(s):  
Qualitative Research ◽  
Systematic Reviews ◽  
Guideline Development ◽  
Evidence Synthesis ◽  
Complex Interventions ◽  
Real Life ◽  
Synthesis Methods ◽  
Qualitative Evidence Synthesis ◽  
Qualitative Evidence ◽  
Broad Term

This paper is one of a series exploring the implications of complexity for systematic reviews and guideline development, commissioned by the WHO. The paper specifically explores the role of qualitative evidence synthesis. Qualitative evidence synthesis is the broad term for the group of methods used to undertake systematic reviews of qualitative research evidence. As an approach, qualitative evidence synthesis is increasingly recognised as having a key role to play in addressing questions relating to intervention or system complexity, and guideline development processes. This is due to the unique role qualitative research can play in establishing the relative importance of outcomes, the acceptability, fidelity and reach of interventions, their feasibility in different settings and potential consequences on equity across populations. This paper outlines the purpose of qualitative evidence synthesis, provides detail of how qualitative evidence syntheses can help establish understanding and explanation of the complexity that can occur in relation to both interventions and systems, and how qualitative evidence syntheses can contribute to evidence to decision frameworks. It provides guidance for the choice of qualitative evidence synthesis methods in the context of guideline development for complex interventions, giving ‘real life’ examples of where this has occurred. Information to support decision-making around choice qualitative evidence synthesis methods in the context of guideline development is provided. Approaches for reporting qualitative evidence syntheses are discussed alongside mechanisms for assessing confidence in the findings of a review.

Use of the Certified Nursing Assistant Pain Assessment Tool (CPAT) in Nursing Home Residents With Dementia

2007 ◽  
Vol 22 (2) ◽  
pp. 112-119 ◽  
Author(s):  
Frank A. Cervo ◽  
Robert P. Raggi ◽  
Lory E. Bright-Long ◽  
William K. Wright ◽  
Ginette Rows ◽  
...  
Keyword(s):  
Nursing Home ◽  
Pain Assessment ◽  
Assessment Tool ◽  
Nursing Home Residents ◽  
Nursing Assistant ◽  
Certified Nursing Assistant

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 Children and young people's experiences of living with developmental coordination disorder/dyspraxia: study protocol for a qualitative evidence synthesis

2020 ◽  
Vol 2 ◽  
pp. 28
Author(s):  
Áine O'Dea ◽  
Susan Coote ◽  
Katie Robinson
Keyword(s):  
Young People ◽  
Developmental Coordination Disorder ◽  
Research Policy ◽  
Evidence Synthesis ◽  
Small Body ◽  
Complex Interventions ◽  
Qualitative Evidence Synthesis ◽  
Children And Young People ◽  
Qualitative Evidence ◽  
Coordination Disorder

Background Children with developmental coordination disorder (DCD) face significant challenges to deal with everyday activities due to underlying motor proficiency difficulties. These challenges affect children and young people’s participation; that is, involvement in daily life situations. A small body of qualitative research  has explored the experiences of children and young people with DCD from their own perspective. Therfore, understanding what it is like to live with DCD is not well conceptualised in the literature. There is a pressing need to synthesise the findings of discrete qualitative studies to advance the conceptual understanding of living with DCD, to inform health service delivery and the development and implementation of complex interventions. Aim This study aims to systematically review and synthesise qualitative literature regarding children and young people’s experiences and views of everyday life and living with DCD. Methods The method of qualitative evidence synthesis that will be followed in this review is a meta-ethnography. The eMERGe and PRISMA reporting guidelines will be adhered to. Ten databases will be searched; Academic Search Complete, AMED, CINAHL, ERIC, MEDLINE, PsychArticles, PsychInfo, EMBASE, SPORTDiscus, and Web of Science. The Joanna Briggs Institute Checklist will be used by two independent reviewers to appraise all included papers. Discussion The findings of this meta-ethnography will endeavour to inform future research, policy and practice. In particular, the results will help to inform the design of future complex interventions to meet the needs of children and young people with DCD. Dissemination will involve the publication of the results in a peer-reviewed journal. Increasingly researchers and policymakers are calling for services to be informed by the perspective and voice of children with DCD. Therefore, a policy brief will be published so that the findings are widely available. Registration: PROSPERO registration number CRD42019129178; registered on 09 July 2019.

scholarly journals Children and young people's experiences of living with developmental coordination disorder/dyspraxia: study protocol for a qualitative evidence synthesis

2021 ◽  
Vol 2 ◽  
pp. 28
Author(s):  
Áine O'Dea ◽  
Susan Coote ◽  
Katie Robinson
Keyword(s):  
Developmental Coordination Disorder ◽  
Research Policy ◽  
Evidence Synthesis ◽  
Complex Interventions ◽  
Future Research ◽  
Qualitative Evidence Synthesis ◽  
Policy And Practice ◽  
Everyday Activities ◽  
Qualitative Evidence ◽  
Coordination Disorder

Background Children with developmental coordination disorder (DCD) face significant challenges to deal with everyday activities due to underlying motor proficiency difficulties. These challenges affect children and young people’s participation; that is, involvement in daily life situations. Recent years have seen a growing body of qualitative research examining children’s experiences of living with DCD.  Meta-ethnographic synthesis offers a rigorous approach to bring together the findings of discrete qualitative studies to be synthesised in order to advance the conceptual understanding of living with DCD, which is not well conceptualised in the literature to date. Conducting a meta-ethnographic synthesis will help to illuminate the meaning of children and young people’s experiences of DCD regarding their involvement in everyday activities and situations. Aim This study aims to systematically review and synthesise qualitative literature regarding children and young people’s experiences and views of everyday life and living with DCD. Methods The method of qualitative evidence synthesis that will be followed in this review is a meta-ethnography. The eMERGe and PRISMA reporting guidelines will be adhered to. Ten databases will be searched; Academic Search Complete, AMED, CINAHL, ERIC, MEDLINE, PsychArticles, PsychInfo, EMBASE, SPORTDiscus, and Web of Science. The Joanna Briggs Institute Checklist will be used by two independent reviewers to appraise all included papers. PROSPERO registration number CRD42019129178 Discussion The findings of this meta-ethnography will endeavour to inform future research, policy and practice. In particular, the results will help to inform the design of future complex interventions to meet the needs of children and young people with DCD. Dissemination will involve the publication of the results in a peer-reviewed journal. Increasingly researchers and policymakers are calling for services to be informed by the perspective and voice of children with DCD. Therefore, a policy brief will be published so that the findings are widely available.

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