Quality Improvement in Long Term Care: The Psychotropic Assessment Tool (PAT)

Dahl, Lindsey; Wright, Rebecca; Xiao, Aiying A.; Keeven, Angela; Carr, David B.

doi:10.1016/j.jamda.2008.07.002

Cited by 27 publications

(38 citation statements)

References 16 publications

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“…The design of the remaining 3 studies permits the consideration of trends in results only. Two used audit and feedback and reminders to review medication needs on a regular basis 33,34 and these resulted in minimal changes in prescribing rates. The final study was conducted against a background of changes in accommodation conditions for the residents such that they were moved into a specialized, secure dementia unit.…”

Section: Medication Review (Randomized [N ¼ 1] and Before And After Smentioning

confidence: 99%

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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Section: Medication Review (Randomized [N ¼ 1] and Before And After Smentioning

confidence: 99%

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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“…cluded audits [14] [22] [23], medication reviews [21], education [15] [17] [20], multidisciplinary case-conferencing [19], early screening [16] and non-pharmacological management [18]. PUM is unique among these interventions as it emphasizes on the monitoring process, leveraging on the capabilities and roles of the pharmacist as the educator and advocator for appropriate medication use [33] and the nursing staff as the keen first-hand observer [34], to support the appropriate APDs by the visiting psychiatrist.…”

Section: Unique Characteristics Of the Pum Interventionmentioning

confidence: 99%

Improving the Appropriateness of Antipsychotic Prescribing for Behavioral and Psychological Symptoms of Dementia (BPSD): A Pilot Study of the Psychotropic Use Monitoring (PUM) Program

Yap¹,

Kua²,

Chan³

et al. 2014

OJPsych

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In nursing homes, antipsychotic prescribing decisions (APDs) for managing behavioral and psychological symptoms of dementia (BPSD) depend on the nursing staff's feedback. Inappropriate APDs can result in the lack of timeliness, objectivity and important clinical information when nursing staff's feedback on residents' behavior and pharmacotherapy outcomes. Currently, there are no reported interventions for improving psychiatrists' APDs through nursing staff's monitoring and feedback processes. This one-group pre-and-post pilot study aimed to evaluate the feasibility and impact of implementing a newly-developed Psychotropic Use Monitoring (PUM) program for improving the appropriateness of APDs in a 50-bed dementia ward of a nursing home. The PUM intervention involved 16 pharmacist-trained nursing staff, who monitored and reported residents' BPSD changes and psychotropic side effects for 24 weeks, while carrying out their routine care duties. A face-to-face interview was then administered to determine the nursing staff's perceptions of PUM. Data of 51 residents were collected from hardcopy individual patient records to evaluate the changes in APDs and the number of resident falls before and after implementing PUM. The nursing staff reported increases in their knowledge, awareness, confidence, and actual frequency of monitoring for side effects, as well as their ability in differentiating and managing BPSD (p < 0.05). After PUM, there was a significant increase in the number of APDs due to side effect-related reasons (4 versus 16) (p < 0.031). Although not significant, the number of APDs with no documented reasons (5 versus 9) and the number of resident falls (7 versus 15) appeared to be lesser after PUM. This study demonstrated the nursing staff's positive participation in PUM inter-* Corresponding author. K. Z. Yap et al. 154vention, specifically in monitoring and feedback of side effects. Furthermore, a potential exists for PUM to encourage more judicious APDs, which may be useful in settings with heavy patient load, limited human resources and dependence on foreign nursing staff from differing cultural backgrounds.

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“…Reported or assumed factors that influence the prescribing of antidepressants include: the physician's experience [61], the opportunity for interdisciplinary communication [106], knowledge about how to prescribe an antidepressant to older patients [107], cautiousness in prescribing [108], personal estimations regarding the therapeutical effect of antidepressants [109,110], the substitutability or complementarity of antidepressants and psychotherapy [111], the physician's concern about the tolerability and safety of prescribed medication [59] or whether the medication increases suicide risk [112], limited time, the physician's own interests, background, and training [113], the physician's conceptualization of depression [107], and the physician's view of their patients [111,114].…”

Section: Physician Characteristicsmentioning

confidence: 99%

Choice of Treatment with Antidepressants: Influencing Factors

Himmerich

Wranik²

2012

CPD

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Depressive disorders place a large burden on patients and on society. Although efficacious treatment options for unipolar depressive disorders exist, substantial gaps in care remain. In part, the challenge lies in the matching of individual patients with appropriate care. This is complicated by the steady increases in the variety of antidepressants available in the market. The goal of this study is to highlight the decision processes in the selection of antidepressants by clinicians, given that most treatments have similar clinical effectiveness profiles. We conducted a systematic literature review of studies that referred to the decisions surrounding treatment with antidepressants for the treatment of non-psychotic unipolar depression. Our analysis of the literature reveals that the choice of treatment is based on a variety of factors, of which clinical evidence is only one. These factors can be categorized into clinical factors such as illness and treatment characteristics, individual factors such as patient and physician characteristics, and contextual factors such as setting characteristics, decision supports and pharmacoeconomic aspects. Illness characteristics are defined by the type and severity of depression. Treatment characteristics include drug properties, efficacy, effectiveness and favorable as well as unintended adverse effects of the drug. Examples for patient characteristics are co-morbidities and individual preferences, and physician characteristics include knowledge, experience, values and beliefs, and the relationship with the patient. Treatment guidelines, algorithms, and most recently, computational supports and biological markers serve as decision supports.

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Quality Improvement in Long Term Care: The Psychotropic Assessment Tool (PAT)

Cited by 27 publications

References 16 publications

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

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

Improving the Appropriateness of Antipsychotic Prescribing for Behavioral and Psychological Symptoms of Dementia (BPSD): A Pilot Study of the Psychotropic Use Monitoring (PUM) Program

Choice of Treatment with Antidepressants: Influencing Factors

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