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PP24 Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications to People with Dementia Living in Residential Care: A Systematic Review
  1. J Thompson Coon1,
  2. R Abbott1,
  3. M Rogers1,
  4. R Whear1,
  5. S Pearson2,
  6. I Lang1,3,
  7. N Cartmell4,
  8. K Stein1
  1. 1Peninsular Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC), University of Exeter Medical School, University of Exeter, Exeter, UK
  2. 2West Devon Older People’s Mental Health (OPMH) Community Team, Devon Partnership NHS Trust, Exeter, UK
  3. 3NHS Devon, Plymouth and Torbay, Exeter, UK
  4. 4Ashburton Surgery, Ashburton, UK

Abstract

Background The use of antipsychotic medications in dementia is associated with increased mortality. A significant proportion of long-term antipsychotic use is believed to be inappropriate. The Department of Health National Dementia Strategy recently targeted a two-thirds reduction in antipsychotic usage. The aim of this review is to explore qualitative and quantitative literature to identify interventions that have been used to reduce inappropriate prescribing of antipsychotics and the barriers and enablers to the implementation of these interventions.

Methods Potentially relevant papers were identified in the following ways i) electronic searches inMedline, PsycINFO, Embase, AMED, Social Policy and Practice including AgeInfo (OvidSp); CDSR, CENTRAL (Cochrane Library); CINAHL (EBSCOhost); British Nursing Index, AMED (NHS Evidence) and Science Citation Index and Social Science Citation Index (Web of Science) from inception to November 2012, ii) forward and backward citation chases, iii) hand searches of review papers identified in the search, iii) searching of relevant organisations’ websites. All comparative studies were included. Screening of articles for inclusion, data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary.

Results Eleven studies (involving staff and patients in 55 care homes) met the inclusion criteria. All reported quantitative data. Studies were conducted in the UK (n = 4), Canada (n = 2), USA (n = 2) Australia (n = 1) and Norway (n = 1). Studies were of varied design with associated quality issues. No papers in which barriers to the implementation of interventions had been studied were identified. All interventions were unique and involved the delivery of an education or training package (n = 5), the use of in-reach teams in which regular visits by psychiatrists, mental health nurses and psychologists enabled regular patient review in the care home (n = 4), audit followed by feedback and re-audit (n = 1) or regular review, education and the development of a behavioural management approach (n = 1). In all studies, the proportion of residents receiving antipsychotic medication was reduced following the intervention.

Conclusion There is some evidence to suggest that simple changes to the way patients are reviewed and monitored and/or enhanced education and training can reduce the prescription rates of antipsychotics for people with dementia living in residential care. In order to guide best practice in this area, further qualitative study is required to explore the barriers and enablers to successful implementation of these interventions. Large rigorous studies with extended post-intervention data collection are also necessary to ascertain the long term impact on prescribing practices.

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