Optimizing Prescribing of Antipsychotics in Long-Term Care

Study Overview
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Brief Summary
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Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in LTC. A multi component intervention to reduce inappropriate antipsychotic prescribing was evaluated in ten Canadian long-term care facilities.

Detailed Description
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Increasing numbers of older adults are affected by dementia, and many will eventually reside in long-term care (LTC), where antipsychotic use is relatively common. Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in LTC but limited evidence exists on the most effective strategies for reducing inappropriate antipsychotic use. The objective of the study was to evaluate a multicomponent approach to reduce inappropriate prescribing of antipsychotics in LTC. A prospective, randomized stepped-wedge, study design was used to evaluate the effect of the intervention in 10 LTC facilities in Canada. The intervention consisted of an educational in-service, provision of evidence-based tools to assess and monitor neuropsychiatric symptoms (NPS) and monthly interprofessional team meetings.

Official Title
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Optimizing Prescribing of Antipsychotics in Long-Term Care (OPAL): A Randomized Trial to Reduce Inappropriate Antipsychotic Prescribing in Long-Term Care

Conditions
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Dementia

Intervention / Treatment
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* Other: Educational


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of dementia Receiving an antipsychotic medication without a diagnosis of psychosis Exclusion Criteria: Diagnoses of schizophrenia, Huntington's disease Presence of active hallucinations and/or delusions Individuals at end of live or receiving palliative care

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Sequential Assignment
Interventional Model Description: Randomized, stepped-wedge cluster trial.
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Educational|Multi component educational intervention in long-term care|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of long-term care residents receiving any antipsychotic without a diagnosis of psychosis | The proportion of long-term care residents receiving any antipsychotic without a diagnosis of psychosis is a quality indicator is used by the Canadian Institute for Health Information to determine potentially inappropriate antipsychotic use. The quality indicator is calculated using information routinely collected on Resident Assessment Index-Minimum Dataset (RAI-MDS) assessments by determining the number of individuals who received antipsychotics on one of more days in the 7 days preceding index (RAI-MDS item O4a ≥ 1). Individuals with schizophrenia, Huntington's disease, hallucinations, delusions, those with a limited life expectancy and those currently receiving palliative care are excluded from the numerator and denominator of this indicator. | 12-months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Worsening of behavioral symptoms | Proportion of residents who had one or more of the following behavioural symptoms: wandering, physically or verbally abusive, or socially inappropriate behaviours) present on their target RAI-MDS assessment than on their prior assessment. | 12-months | 
| Use of physical restraints | Proportion of residents in daily physical restraints as of the target RAI-MDS assessment. | 12-months | 
| Depression: Proportion of residents whose mood from symptoms of depression worsened | Proportion of residents whose mood from symptoms of depression worsened compared to the previous RAI-MDS assessment. | 12-months | 
| Falls: Proportion of residents experiencing a fall in the 30 day | Proportion of residents experiencing a fall in the 30 days preceding the RAI-MDS assessment. | 12-months | 
| Pain: Proportion of residents who had pain | Proportion of residents who had pain on their target RAI=MDS assessment. | 12-months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Antipsychotic, Nursing home, Long-term care