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Optimizing Prescribing of Antipsychotics in Long-Term Care (OPAL): A Stepped-Wedge Trial.

Abstract：

BACKGROUND:Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in long-term care (LTC), but limited evidence exists on the most effective strategies for reducing inappropriate antipsychotic use. OBJECTIVES:The objective of the study was to evaluate a multicomponent approach to reduce inappropriate prescribing of antipsychotics in LTC. DESIGN:A prospective, stepped-wedge study design was used to evaluate the effect of the intervention. SETTINGS AND PARTICIPANTS:Interdisciplinary staff at 10 Canadian LTC facilities. METHODS:The intervention consisted of an educational in-service, provision of evidence-based tools to assess and monitor neuropsychiatric symptoms (NPS) in dementia, and monthly interprofessional team meetings. The primary outcome was the proportion of residents receiving an antipsychotic without a diagnosis of psychosis using a standardized antipsychotic quality indicator. RESULTS:The weighted mean change in inappropriate antipsychotic prescribing rate from baseline to 12-month follow-up was -4.6% [standard deviation (SD) = 2.8%, P < .0001], representing a 16.1% (SD = 17.0) relative reduction. After adjusting for site, the odds ratio for the inappropriate antipsychotic prescribing quality indicator at 12 months compared to baseline was 0.73 (95% confidence interval = 0.48-0.94; chi-square = 6.59; P = .01). There were no significant changes in related quality indicators, including falls, restraint use, or behavioral symptoms. CONCLUSIONS AND IMPLICATIONS:This multicomponent intervention was effective in reducing inappropriate antipsychotic prescribing in LTC without adversely affecting other domains related to quality of care, and offers a practical means by which to improve the care of older adults with dementia in LTC.

journal_name

J Am Med Dir Assoc

journal_title

Journal of the American Medical Directors Association

authors

Kirkham J,Maxwell C,Velkers C,Leung R,Moffat K,Seitz D

doi

10.1016/j.jamda.2019.07.025

subject

Has Abstract

pub_date

2020-03-01 00:00:00

pages

381-387.e3

issue

3

eissn

1525-8610

issn

1538-9375

pii

S1525-8610(19)30585-7

journal_volume

21

pub_type

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