Not less but different: psychotropic drug utilization trends in Norwegian nursing homes during a 12-year period. The Bergen District Nursing Home (BEDNURS) Study

Nygaard, Harald A.; Ruths, Sabine; Straand, Jørúnd; Naik, Mala

doi:10.1007/bf03324552

Cited by 22 publications

(19 citation statements)

References 32 publications

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“…In this case, the last author (KRI), a GP serving as a nursing home doctor, noticed that the use of antidepressant medication among the residents may not be optimal. Her observations were substantiated by evidence that nursing home patients use a large amount of medication in general, especially antidepressants [ 25 , 26 ]. Antidepressants in the elderly are associated with serious side-effects, and the quality of treatment is crucial [ 27 – 29 ].…”

Section: Main Textmentioning

confidence: 99%

Small-scale implementation with pragmatic process evaluation: a model developed in primary health care

2018

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BackgroundResearch often fails to impose substantial shifts in clinical practice. Evidence-based health care requires implementation of documented interventions, with implementation research as a science-informed strategy to identify core experiences from the process and share preconditions for achievement. Evidence developed in hospital contexts is often neither relevant nor feasible for primary care. Different evidence types may constitute a point of departure, stretching and testing the transferability of the intervention by piloting it in primary care. Comprehensive descriptions of aims, context and procedures can be a more useful outcome than traditional effect studies.Main textWe present a model for small-scale implementation of relevant research evidence, monitored by pragmatic evaluation. The model, which is applicable in primary care, is supported by Weiner’s theory about organizational readiness for change and consists of four steps: 1) recognize the problem – identify a workable intervention, 2) assess the context – prepare for inception, 3) pilot the intervention on site, and 4) upscale and accomplish the intervention. The process is evaluated by exploring selected relevant aspects of experiences and outcomes from the first to the last step. Process evaluation is a logical precondition for outcome evaluation – attempting to assess either the efficacy or the effectiveness of a “black box” intervention makes no sense. We argue why evidence beyond effect studies and evaluation beyond randomized controlled trials may be adequate for science-informed evaluation of a small-scale implementation project such as is often conducted by primary health care practitioners. The model is illustrated by an ongoing project, in which a strategy for upgrading the management of depression in nursing homes in Norway is currently being implemented.ConclusionsA flexible and manageable approach is suggested, in which the inevitable unpredictability of clinical practice is incorporated. Finding the appropriate middle ground between rigour and flexibility, some compromises must be made. Our model recognizes the skills of practical knowing as something other than traditional medical research, while maintaining academic values such as systematic and transparent reflection, using adequate tools. Considering the purpose and context of our model, we argue that these priorities, emphasizing relevance and feasibility, are strengths, not limitations.

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Section: Main Textmentioning

confidence: 99%

Small-scale implementation with pragmatic process evaluation: a model developed in primary health care

2018

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“…There have also been great changes in the pharmacological management of psychiatric symptoms in people in geriatric care (Arthur et al, 2002;Lopez et al, 2003;Nygaard et al, 2004). The use of antidepressants and benzodiazepines have become much more common in Sweden (Sandman et al, 1988;Lövheim et al, 2006a).…”

Section: Introductionmentioning

confidence: 97%

Symptoms of mental health and psychotropic drug use among old people in geriatric care, changes between 1982 and 2000

Lövheim

Sandman

Kallin

et al. 2007

Int J Geriat Psychiatry

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“…Psychiatric and behavioural symptoms put a heavy strain on professional carers (Sourial et al, 2001). This might lead to excessive use of psychotropic drugs and constraints (Nygaard et al, 2004;Kirkevold and Engedal, 2005). In spite of this, comparatively few studies have explored the prevalence of the symptoms in long-term care settings, and results have been difficult to interpret because of small sample sizes, various populations and the use of different assessment methods.…”

Section: Introductionmentioning

confidence: 99%

The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes

Selbæk

Kirkevold

Engedal

2006

Int J Geriat Psychiatry

335

356

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Not less but different: psychotropic drug utilization trends in Norwegian nursing homes during a 12-year period. The Bergen District Nursing Home (BEDNURS) Study

Abstract: During the study period, a substantial decline in the use of antipsychotics was observed, but a generally increased overall use of psychotropic drugs, particularly antidepressants. Psychotropic drug treatment was mainly associated with behavioral symptoms.

Cited by 22 publications

References 32 publications

Small-scale implementation with pragmatic process evaluation: a model developed in primary health care

Small-scale implementation with pragmatic process evaluation: a model developed in primary health care

Symptoms of mental health and psychotropic drug use among old people in geriatric care, changes between 1982 and 2000

The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes

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