Antipsychotic prescribing in dementia patients in care homes: proactive in‐reach service improved quality of care

Chakraborty, Arpita; Linton, Caroline

doi:10.1002/gps.2827

Cited by 7 publications

(5 citation statements)

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“…It is estimated that 30% to 50% of residents are routinely prescribed APMs, 4-7 a figure that may be an underestimate. 14 Despite these concerns, the off-label use of APMs for the treatment of BPSD 15,16 remains common, particularly among institutionalized residents. 8 A landmark 2006 meta-analysis of 17 placebo-controlled trials revealed a significant mortality increase among institutionalized older adults receiving atypical APMs, 9 which led to a black-box warning of the risks associated with APM use in the treatment of the BPSD.…”

Section: Introductionmentioning

confidence: 99%

“…While atypical APMs are preferred, there is still a substantial population receiving conventional APMs to treat BPSD. 11,16 Reasons for increased mortality risk are poorly understood, but it is plausible that increased mortality could be due to idiosyncrasies of the drug itself or to extrapyramidal effects. 10 Subsequent reviews and observational studies report varying levels of effectiveness and a moderate to high risk of adverse health events including respiratory failure, 11 pneumonia, 12 cardiovascular events, 13 and mortality.…”

Section: Introductionmentioning

confidence: 99%

“…10 Subsequent reviews and observational studies report varying levels of effectiveness and a moderate to high risk of adverse health events including respiratory failure, 11 pneumonia, 12 cardiovascular events, 13 and mortality. 14 Despite these concerns, the off-label use of APMs for the treatment of BPSD 15,16 remains common, particularly among institutionalized residents. 11,16 Reasons for increased mortality risk are poorly understood, but it is plausible that increased mortality could be due to idiosyncrasies of the drug itself or to extrapyramidal effects.…”

Section: Introductionmentioning

confidence: 99%

“…14 Despite these concerns, the off-label use of APMs for the treatment of BPSD 15,16 remains common, particularly among institutionalized residents. 11,16 Reasons for increased mortality risk are poorly understood, but it is plausible that increased mortality could be due to idiosyncrasies of the drug itself or to extrapyramidal effects.…”

Section: Introductionmentioning

confidence: 99%

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Intermittent antipsychotic medication and mortality in institutionalized older adults: A scoping review

Randle

Heckman

Oremus

et al. 2019

Int J Geriat Psychiatry

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Objective/Background Antipsychotic use appears to increase mortality risk among older adults with dementia. Whether this risk is similar for regular or intermittent use is unknown. This scoping review aims to explore the temporal association between antipsychotic use and mortality risk for older institutionalized adults. Method We conducted a scoping review using Medline (PubMed), EMBASE, CINAHL, and the Cochrane libraries between October 2018 and January 2019. Results Twenty‐eight articles met review criteria. We found that different antipsychotic medications present different safety profiles. The risk of mortality was highest with conventional antipsychotic use and within 40 days of antipsychotic initiation. Conclusions Conventional antipsychotic use increases mortality for older institutionalized adults. The evidence for atypical antipsychotics is less clear. Mortality risk appears highest within 30 to 40 days of initiating antipsychotic treatment. This temporal association suggests increased mortality may actually be the result of some previously unrecognized illness, comorbidity, change in health status, or increased frailty, rather than an idiosyncrasy of the antipsychotic itself.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intermittent antipsychotic medication and mortality in institutionalized older adults: A scoping review

Randle

Heckman

Oremus

et al. 2019

Int J Geriat Psychiatry

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“…A recent systematic review identified 22 interventions that have been developed to address inappropriate antipsychotic use in nursing homes [ 4 ]. This review noted that medication audit initiatives typically collect data by visiting the home and copying resident charts [ 4 , 10 , 11 ] using cohorts already detailed by other studies [ 12 , 13 ] or by accessing electronic pharmacy records [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

An Internet-Based Method for Extracting Nursing Home Resident Sedative Medication Data From Pharmacy Packing Systems: Descriptive Evaluation

et al. 2017

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BackgroundInappropriate use of sedating medication has been reported in nursing homes for several decades. The Reducing Use of Sedatives (RedUSe) project was designed to address this issue through a combination of audit, feedback, staff education, and medication review. The project significantly reduced sedative use in a controlled trial of 25 Tasmanian nursing homes. To expand the project to 150 nursing homes across Australia, an improved and scalable method of data collection was required. This paper describes and evaluates a method for remotely extracting, transforming, and validating electronic resident and medication data from community pharmacies supplying medications to nursing homes.ObjectiveThe aim of this study was to develop and evaluate an electronic method for extracting and enriching data on psychotropic medication use in nursing homes, on a national scale.MethodsAn application uploaded resident details and medication data from computerized medication packing systems in the pharmacies supplying participating nursing homes. The server converted medication codes used by the packing systems to Australian Medicines Terminology coding and subsequently to Anatomical Therapeutic Chemical (ATC) codes for grouping. Medications of interest, in this case antipsychotics and benzodiazepines, were automatically identified and quantified during the upload. This data was then validated on the Web by project staff and a “champion nurse” at the participating home.ResultsOf participating nursing homes, 94.6% (142/150) had resident and medication records uploaded. Facilitating an upload for one pharmacy took an average of 15 min. A total of 17,722 resident profiles were extracted, representing 95.6% (17,722/18,537) of the homes’ residents. For these, 546,535 medication records were extracted, of which, 28,053 were identified as antipsychotics or benzodiazepines. Of these, 8.17% (2291/28,053) were modified during validation and verification stages, and 4.75% (1398/29,451) were added. The champion nurse required a mean of 33 min website interaction to verify data, compared with 60 min for manual data entry.ConclusionsThe results show that the electronic data collection process is accurate: 95.25% (28,053/29,451) of sedative medications being taken by residents were identified and, of those, 91.83% (25,762/28,053) were correct without any manual intervention. The process worked effectively for nearly all homes. Although the pharmacy packing systems contain some invalid patient records, and data is sometimes incorrectly recorded, validation steps can overcome these problems and provide sufficiently accurate data for the purposes of reporting medication use in individual nursing homes.

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Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications in People With Dementia Resident in Care Homes: A Systematic Review

Thompson-Coon

Abbott

Rogers

et al. 2014

Journal of the American Medical Directors Association

118

116

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Antipsychotic prescribing in dementia patients in care homes: proactive in‐reach service improved quality of care

Cited by 7 publications

References 0 publications

Intermittent antipsychotic medication and mortality in institutionalized older adults: A scoping review

Intermittent antipsychotic medication and mortality in institutionalized older adults: A scoping review

An Internet-Based Method for Extracting Nursing Home Resident Sedative Medication Data From Pharmacy Packing Systems: Descriptive Evaluation

Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications in People With Dementia Resident in Care Homes: A Systematic Review

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