July 19, 2017

Multicomponent Intervention Reduces Inappropriate Antipsychotic Use in Older Patients

By Jill Stein

LONDON -- July 19, 2017 -- A multicomponent approach that includes an educational program reduces inappropriate antipsychotic prescribing in long-term care facilities, according to a study presented here at the 2017 Annual Meeting of the Alzheimer's Association International Conference (AAIC).

Julia Kirkham, MD, Queen’s University, Kingston, Ontario, and colleagues tested the intervention in 10 long-term care facilities in Ontario and Saskatchewan. The intervention included an educational in-service, the provision of evidence-based tools to assess and monitor neuropsychiatric symptoms, and facilitation of monthly long-term care team meetings to discuss and identify individuals in whom antipsychotics may be reduced or discontinued.

Staff attending the sessions varied widely depending on the site and included clinicians (physicians, nurses, pharmacists), allied health personnel (food services coordinators, recreational therapists, and social workers), and non-clinical administrative personnel.

The primary outcome of the study was the rate of inappropriate antipsychotic prescribing, defined as the percentage of residents who received antipsychotics without a diagnosis of psychosis, according to the Canadian Institute for Health Information antipsychotic indicator.

The pre-implementation mean rate of inappropriate antipsychotic prescribing was 28.4%. At 12 months following implementation of the intervention, the mean rate had decreased to 23.8%. The absolute change in the inappropriate antipsychotic prescribing rate was -4.9%.

Overall, there was a 26.9% relative reduction in antipsychotic use at the post-implementation assessment compared with baseline (relative odds = 0.78; 95% confidence interval, 0.65-0.95; P = .01).

Changes in other quality indicators including the percentage of residents experiencing a fall, behavioural worsening, and physical restraint use were not significant.

Dr. Kirkham said that she is encouraged by the findings even though the change in inappropriate antipsychotic prescribing was not significant.

“If effective in the final evaluation, the intervention offers a practical approach to reducing inappropriate prescribing that can be easily disseminated more widely despite limited resources,” she said.

[Presentation title: Optimising Prescribing of Antipsychotics in Long-Term Care (OPAL). Abstract A14169]

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