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Assessment of antipsychotic prescribing in Belgian nursing homes

Published online by Cambridge University Press:  22 March 2011

Majda Azermai ,
Monique Elseviers ,
Mirko Petrovic ,
Luc van Bortel  and
Robert Vander Stichele
Majda Azermai*
Affiliation:
Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
Monique Elseviers
Affiliation:
Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium Department of Nursing Science, University of Antwerp, Antwerp, Belgium
Mirko Petrovic
Affiliation:
Geriatric Service, Ghent University Hospital, Ghent, Belgium
Luc van Bortel
Affiliation:
Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
Robert Vander Stichele
Affiliation:
Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
*
Correspondence should be addressed to: Majda Azermai, Ghent University, Heymans Institute of Pharmacology, De Pintelaan 185 (1 Blok B), 9000 Gent, Belgium. Phone: +32 9 332 33 47; Fax: +32 9 332 49 88. Email: majda.azermai@ugent.be.
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Abstract

Background: Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes.

Methods: Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP).

Results: The residents' mean age was 84.8 years, 78.1% of whom were female. The prevalence of antipsychotic utilization was 32.9%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95% CI: 2.61–4.09), insomnia (OR: 1.38; 95% CI: 1.10–1.73), depression (OR: 1.30; 95% CI: 1.03–1.65), and age <80 years (OR: 1.79; 95% CI: 1.38–2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6%), use despite risk of falling (45.6%), combined use with other psychotropics (31.8%), and duplicate use (15.1%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17).

Conclusion: The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.

Keywords

inappropriate prescribingprescribing quality indicatorsantipsychoticsolder adultshomes for the aged
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 8 , October 2011 , pp. 1240 - 1248
Copyright
Copyright © International Psychogeriatric Association 2011

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