Antipsychotics successfully reduced in nursing homes

Thursday, 17 May, 2018

Antipsychotics successfully reduced in nursing homes

Inappropriately high rates of psychotropic prescribing in Australian residential aged care facilities (RACFs) have been reported for several decades, despite media and political attention and guidelines for reducing use.

However, this can now change, thanks to a new intervention successfully tested by Australian researchers.

A targeted, multistrategic, interdisciplinary intervention has been found to reduce overprescription of antipsychotics and benzodiazepines in RACFs, according to research published in the Medical Journal of Australia.

Antipsychotics are commonly prescribed to treat the behavioural and psychological symptoms of dementia, although their effectiveness in this role is “modest, and the associated risks are severe, including falls, stroke, and death”. Benzodiazepines can be effective for the short-term treatment of sleep disturbances, anxiety and agitation, but their use in older people is associated with increased risks of falls, pneumonia and death.

Researchers from the Wicking Dementia Research and Education Centre at the University of Tasmania tested an intervention called RedUSe (Reducing Use of Sedatives) in 150 RACFs across the country accommodating a total of 12,157 residents. The program included a psychotropic medication audit and feedback; staff education delivered by community pharmacists; and interdisciplinary case reviews at baseline and three months, with a final audit six months after the start of the program.

“During the six-month intervention, the proportion of residents prescribed antipsychotics declined by 13% and that of residents regularly prescribed benzodiazepines by 21%,” the researchers, led by Dr Juanita Westbury, a senior lecturer in Dementia Care, wrote.

They also found that the mean daily dosages of both antipsychotics and benzodiazepines dropped. “For 39% of residents prescribed antipsychotics and benzodiazepines at baseline, these agents had been ceased or their doses reduced by six months [following the intervention]. There was no substitution by sedating antidepressants or prn prescribing of these agents.

“As mortality and fall rates have been linked to higher doses and longer duration of psychotropic medication, RedUSe can have an effect on these important outcomes.

“A recent Australian study in 17 NSW RACFs found that less than 5% of prescribed psychotropic medications were ceased or their doses reduced in routine practice over six months. Our finding that the prescribing of antipsychotics and benzodiazepines had been reduced or ceased altogether for 39% of residents over six months shows that a multistrategic, interprofessional intervention can markedly increase the frequency of review of these medications for potential discontinuation, consistent with guideline recommendations.”

Dr Westbury and her colleagues called for RedUSe to be more widely adopted. Many of its strategies can be delivered within the present ‘Quality Use of Medicine’ (QUM) program administered through the Pharmacy Guild, which are designed to assist RACFs in meeting the healthcare needs of residents.

“The program should be made available to all Australian RACFs to reduce the inappropriate prescribing of psychotropic medications,” they concluded.

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