Optimizing Practices, Use, Care, and Services–Antipsychotics (OPUS-AP) in Long-Term Care Centers in Quebec, Canada: A Successful Scale-Up

Cossette, Benoȋt; Bruneau, Marie‐Andrée; Morin, Michèle; Gilbert, Suzanne; Boyer, Diane B.; Donald, Tanya Mac; Rhéaume, Andrée-Anne; Gaied, Nouha Ben; Tousignant, Marilyn; Turcotte, Jean-Philippe; Rodrigue, Claudie; Rouleau, Rachel; Couturier, Yves

doi:10.1016/j.jamda.2021.12.031

Cited by 4 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While low, the prevalence of depression in our study is in line with that reported in a recent Quebec (Canada) study (7.6%) [ 50 ]. Nonetheless, both statistics are 2 to 3 times less than those reported in other Canadian or abroad LTC (approximately 30% [ 2 , 49 ]).…”

Section: Discussionsupporting

confidence: 92%

The External Validation of the Nursing Homes Short Depression Inventory in Older Adults with Major Neurocognitive Disorders in Long-Term Care Centers

Toulouse,

Carrier,

Villemure

et al. 2023

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

Introduction: Depression is often difficult to detect in long-term care (LTC) patients with major neurocognitive disorders (MNCD) and an observer-rated screening scale could facilitate assessments. This study aimed to establish the external validity and reliability of the Nursing Homes Short Depression Inventory (NH-SDI) in LTC patients with MNCD and to compare its estimates to the Cornell Scale for Depression in Dementia (CSDD), the most used scale for depression in MNCD. Methods: A focus discussion group of experts assessed the content validity of the NH-SDI. Then, a convenience sample of 93 LTC patients with MNCD were observer-rated by trained nurses with the NH-SDI and CSDD. For 57 patients, a medical assessment of depression was obtained, and screening accuracy estimates generated. Results: The prevalence of depression was 8.8% as per reference standard. NH-SDI's content validity was judged acceptable with minor item wording modifications and specifications. The NH-SDI (cut-off > 3) achieved 100% (95%CI: 46-100%) sensitivity, 83% (95%CI: 69-91%) specificity and 36% (95%CI: 14-64%) positive predictive value (PPV). The CSDD (cut-off > 3) achieved 100% (95%CI: 46-100%) sensitivity, 75% (95%CI: 61-86%) specificity and 28% (95%CI: 11-54%) PPV. No significant differences in AUCs were found between scales. The NH-SDI and CSDD were highly correlated (rs = 0.913; p < 0.001) and reliable (ICC = 0.77, p < 0.001). Discussion/Conclusion: The NH-SDI appears valid and reliable in LTC patients with MNCD and quicker than the CSDD to rule-out depression in a busy or short-staffed setting.

show abstract

Section: Discussionsupporting

confidence: 92%

The External Validation of the Nursing Homes Short Depression Inventory in Older Adults with Major Neurocognitive Disorders in Long-Term Care Centers

Toulouse,

Carrier,

Villemure

et al. 2023

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

show abstract

“…However, up to 80% [2,14,15] of LTC patients are diagnosed with a major neurocognitive disorder (MNCD), a comorbidity known to challenge the accurate detection of depression. Indeed, these comorbidities share several manifestations (e.g., agitation and aggressivity [16]), and MNCDs are associated with significant cognitive decline (e.g., communication and memory) [17], which may limit the validity and clinical utility of existing patient-reported outcome measures (PROMs) [18] (e.g., the Geriatric Depression Scale [GDS] [19] and the Patient Health Questionnaire [PHQ-9] [20]).…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Observer-Rated Measurement Scales for Depression Assessment in Patients with Major Neurocognitive Disorders Residing in Long-Term Care Centers: A Systematic Review

Toulouse

Carrier

Villemure

et al. 2023

Dement Geriatr Cogn Disord

View full text Add to dashboard Cite

Introduction: Depression is often under-detected in long-term care (LTC) patients with major neurocognitive disorders (MNCD) and is associated with important morbidity, mortality, and costs. Observer-rated outcome measures (ObsROMs) could help resolve this problematic; however, evidence on their accuracy is scattered in the literature. This systematic review aimed at summarizing this evidence. Methods: A literature search was conducted in 7 databases using keywords, MeSHs, and bibliographic searches. We included studies published before January 2022 and reporting on the accuracy of a depression ObsROM used in LTC patients with MNCD. Data extraction, analysis, synthesis, and study methodological quality assessments were done by two authors, and discrepancies were resolved by consensus. Results: Among 9,660 articles retrieved, 8 studies reporting on 11 depression measures were included. Scales were classified as patient-reported outcome measures used as ObsROMs or true ObsROMs. Among the first category, the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Asberg Depression Rating Scale (MADRS) performed best (area under the curve [AUC]: 0.73–0.87), although both presented with low positive predictive values and high negative predictive values. Among the second category, the Nursing Homes Short Depression Inventory (NH-SDI) performed best, with an AUC of 0.93 and ≥85% sensitivity, specificity, and predictive values. Conclusion: The CSDD and MADRS may be useful to rule out depression in LTC patients with MNCD, whereas the NH-SDI may be useful to rule in and out depression within this same population. Before recommending their use, adequately powered studies to further examine their accuracy in different contexts are necessary.

show abstract

“…The RAPID project has similarities with the larger-scale Optimising Practices, Use, Care, and Services–Antipsychotics (OPUS-AP) programme that was conducted in Quebec, Canada. 37 , 38 , 39 The OPUS-AP programme aimed to improve long-term care (LTC) residents' care through increased knowledge and competency among staff, resident-centred approaches, non-pharmacological interventions, and by deprescribing antipsychotics when appropriate. The authors found that the OPUS-AP programme was successfully implemented in 24 long term LTC centres initially and then in 129 LTC centres, resulting in a significant reduction in antipsychotic use, as well as improvement in BPSD, and reductions in benzodiazepine use and falls in residents with successful antipsychotic deprescribing.…”

Section: Discussionmentioning

confidence: 99%

“…The authors found that the OPUS-AP programme was successfully implemented in 24 long term LTC centres initially and then in 129 LTC centres, resulting in a significant reduction in antipsychotic use, as well as improvement in BPSD, and reductions in benzodiazepine use and falls in residents with successful antipsychotic deprescribing. 37 , 38 An embedded qualitative study identified certain conditions that were conducive to scaling up the OPUS-AP programme. These conditions comprised: communications in support of the process; an integrated, collaborative and evidence-based approach; an implementation climate conducive to change; stakeholder engagement at the strategic, tactical and operational levels; and an integrated knowledge translation strategy.…”

Section: Discussionmentioning

confidence: 99%

Rationalising Antipsychotic Prescribing in Dementia (RAPID) complex intervention: A mixed-methods feasibility intervention study

Walsh¹,

Byrne²,

O'Riordan³

et al. 2022

Exploratory Research in Clinical and Social Pharmacy

View full text Add to dashboard Cite

Optimizing Practices, Use, Care, and Services–Antipsychotics (OPUS-AP) in Long-Term Care Centers in Quebec, Canada: A Successful Scale-Up

Cited by 4 publications

References 12 publications

The External Validation of the Nursing Homes Short Depression Inventory in Older Adults with Major Neurocognitive Disorders in Long-Term Care Centers

The External Validation of the Nursing Homes Short Depression Inventory in Older Adults with Major Neurocognitive Disorders in Long-Term Care Centers

Accuracy of Observer-Rated Measurement Scales for Depression Assessment in Patients with Major Neurocognitive Disorders Residing in Long-Term Care Centers: A Systematic Review

Rationalising Antipsychotic Prescribing in Dementia (RAPID) complex intervention: A mixed-methods feasibility intervention study

Contact Info

Product

Resources

About