Hostname: page-component-cd9895bd7-fscjk Total loading time: 0 Render date: 2024-12-26T21:38:44.621Z Has data issue: false hasContentIssue false
  • English
  • Français

A 12-month follow-up study of “RedUSe”: a trial aimed at reducing antipsychotic and benzodiazepine use in nursing homes

Published online by Cambridge University Press:  24 March 2011

Juanita Westbury ,
Lisette Tichelaar ,
Gregory Peterson ,
Peter Gee  and
Shane Jackson
Juanita Westbury*
Affiliation:
Unit for Medication Outcomes, Research and Education, School of Pharmacy, University of Tasmania, Sandy Bay, Tasmania, Australia
Lisette Tichelaar
Affiliation:
Department of Pharmacotherapy and Pharmaceutical Care, Pharmacy and Pharmaceutical Science, University of Groningen, Groningen, The Netherlands
Gregory Peterson
Affiliation:
Unit for Medication Outcomes, Research and Education, School of Pharmacy, University of Tasmania, Sandy Bay, Tasmania, Australia
Peter Gee
Affiliation:
Unit for Medication Outcomes, Research and Education, School of Pharmacy, University of Tasmania, Sandy Bay, Tasmania, Australia
Shane Jackson
Affiliation:
Unit for Medication Outcomes, Research and Education, School of Pharmacy, University of Tasmania, Sandy Bay, Tasmania, Australia
*
Correspondence should be addressed to: Juanita Westbury, MSc, BPharm, University of Tasmania, Unit of Medication Outcomes Research and Education, School of Pharmacy, Locked Bag 26, Hobart, Tasmania 7001. Phone: +61 3 6226 1966; Fax: +61 3 6226 7627. Email: Juanita.Westbury@utas.edu.au.
Get access

Abstract

Background: To assess the long-term impact of the “Reducing Use of Sedatives” (RedUSe) trial on antipsychotic and benzodiazepine prevalence and dosage.

Methods: RedUSe was a six-month controlled trial conducted in 25 Tasmanian nursing homes in 2008–9 which led to significant reductions in benzodiazepine and antipsychotic use and a doubling of dose reductions of these agents. In a follow-up study, data on psychotropic use was collected from all nursing homes a year after the final RedUSe measure. Mean daily doses for each home were calculated by converting antipsychotic and benzodiazepine doses to chlorpromazine and diazepam equivalents, respectively. To determine the long-term impact of the project, 6-month and initial baseline data were compared to the 18-month follow-up data.

Results: 1578 residents were audited for the follow-up measure. In the 18 months since the RedUSe project was instigated, benzodiazepine prevalence fell by 25% in intervention nursing homes. Similarly, the mean daily diazepam equivalence in these homes had fallen by 24%. In contrast, after a significant reduction during the RedUSe trial, antipsychotic prevalence returned to baseline levels in intervention nursing homes, with mean chlorpromazine equivalence remaining relatively constant with time. There was a delayed reduction in benzodiazepine and antipsychotic use in the control homes.

Conclusions: Both benzodiazepine usage and mean daily diazepam equivalence continued to decline in intervention nursing homes in the year following the RedUSe trial. However, the effect of the RedUSe intervention on antipsychotic prevalence and dosage was not sustained.

Keywords

psychotropicaged care homesinterventionmultidisciplinary care
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 8 , October 2011 , pp. 1260 - 1269
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aged Care Standards and Accreditation Agency (2011). Accreditation Overview. Available at www.accreditation.org.au/accrediation; last accessed 20 January 2011.Google Scholar
American Psychiatric Association (2007). Practice Guideline for the Treatment of Patients with Alzheimer's Disease and Other Dementias. 2nd edition. Available at: http://www.psych.org; last accessed 11 November 2008.Google Scholar
Avorn, J. et al. (1992). A randomised trial of a program to reduce the use of psychoactive drugs in nursing homes. New England Journal of Medicine, 327, 168–173.CrossRefGoogle ScholarPubMed
Ballard, C., Waite, J. and Birks, J. (2006). Atypical antipsychotics for aggression and psychosis in Alzheimer's disease. Cochrane Database of Systematic Reviews, 1, CD003476.Google Scholar
Ballard, C. et al. (2009). The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurology, 8, 151–157.Google Scholar
Banerjee, S. (2009). The Use of Antipsychotic Medication for People with Dementia: Time for Action. London: Department of Health.Google Scholar
Conn, D. and Madan, R. (2006). Use of sleep-promoting medications in nursing home residents. Drugs and Aging, 23, 271–287.CrossRefGoogle ScholarPubMed
Fossey, J., Ballard, C. and Juszczak, E. (2006). Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial. BMJ, 332, 756–761.Google Scholar
Gauthier, S. et al. (2010). Management of behavioral problems in Alzheimer's disease. International Psychogeriatrics, 22, 346–372.CrossRefGoogle ScholarPubMed
Glass, J., Lanctot, K., Herrmann, N., Sproule, B. and Busto, U. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 331, 1169–1176.CrossRefGoogle ScholarPubMed
International Psychogeriatric Association (2004). Primary Care Physicians Guide to BPSD. Available at www.ipa-online.net; last accessed 14 March 2009.Google Scholar
Jeste, D. et al. (2008). ACNP White Paper: update on use of antipsychotic drugs in elderly persons with dementia. Neuropsychopharmacology, 33, 957–970.Google Scholar
Kamble, P. et al. (2008). Antipsychotic drug use among elderly nursing home residents in the United States. American Journal of Geriatric Pharmacotherapy, 6, 178–197.CrossRefGoogle ScholarPubMed
National Prescribing Service (2008). Medication Management in Residential Aged Care: Drugs for Dementia in Alzheimer's Disease. Canberra: National Prescribing Service. Available at: http://agedcare.nps.org.au/clinical_info/feature_topics/topics/feature_topic; last accessed 10 October 2010.Google Scholar
Nishtala, P., McLachlan, A., Bell, J. and Chen, T. (2008). Psychotropic prescribing in long-term care facilities: Impact of Medication Reviews and Educational Interventions. American Journal of Geriatric Psychiatry, 16, 621–632.Google Scholar
Ray, W., Blazer, D., Schaffner, W. and Federspiel, C. (1987). Reducing antipsychotic drug prescribing for nursing home patients: a controlled trial of the effect of an educational visit. American Journal of Public Health, 77, 1448–1450.CrossRefGoogle ScholarPubMed
Royal Australian College of General Practitioners (2000). Guidelines for the Rational Use of Benzodiazepines. Available at www.racgp.org.au/publications. Last accessed 6 March 2009.Google Scholar
Schmidt, I. and Fastbom, J. (2000). Quality of drug use in Swedish nursing homes: a follow-up study. Clinical Drug Investigations, 20, 433–446.CrossRefGoogle Scholar
Schmidt, I., Claesson, C., Westerholm, B., Nilsson, L. and Svarstad, B. (1998). The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish Nursing homes Journal of the American Geriatric Society, 46, 77–82.CrossRefGoogle ScholarPubMed
Schneider, L., Dagerman, M. and Insel, P. (2006). Efficacy and adverse effects of atypical antipsychotics for dementia: Meta-analysis of randomised, placebo-controlled trials. American Journal of Geriatric Psychiatry, 14, 191–210.Google Scholar
Snowdon, J., Day, S. and Baker, W. (2005). Current use of psychotropic medication in nursing homes. International Psychogeriatrics, 17, 1–10.Google Scholar
South London and Maudsley NHS Foundation Trust Oxleas NHS Foundation Trust (2010). Maudsley Prescribing Guidelines. 10th edition. London: Informa.Google Scholar
Tucker, M. and Hosford, I. (2008). Use of psychotropic medicines in residential care facilities for older people in Hawke's Bay, New Zealand. New Zealand Journal of Medicine, 121, 18–25.Google Scholar
Valiyeva, E., Herrmann, N., Rochon, P., Gill, S. and Anderson, G. (2008). Effect of regulatory warnings on antipsychotic prescription rates among elderly patients with dementia: a population-based time-series analysis. Canadian Medical Journal, 179, 438–446.Google ScholarPubMed
Westbury, J., Jackson, S., Gee, P. and Peterson, G. (2010). An effective approach to decrease antipsychotic and benzodiazepine use in nursing homes International Psychogeriatrics, 22, 26–36.Google Scholar
Woods, S. (2003). Chlorpromazine equivalent doses for the newer atypical antipsychotics. Journal of Clinical Psychiatry, 64, 663–637.CrossRefGoogle ScholarPubMed
World Health Organization (2006). Guidelines for ATC Classification and DDD Assignment. 9th edition. Oslo: WHO Collaborating Centre for Drug Statistics.Google Scholar
Zachary, M., Handler, S., Wright, R. and Hanlon, J. (2010). Interventions to improve suboptimal prescribing in nursing homes: a narrative review. American Journal of Geriatric Pharmacotherapy, 8, 183–200.Google Scholar