Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-11T09:00:17.498Z Has data issue: false hasContentIssue false
  • English
  • Français

Implementing a multidisciplinary psychotropic medication review among nursing home residents with dementia: a process evaluation

Published online by Cambridge University Press:  27 August 2019

Debby L. Gerritsen ,
Erica de Vries ,
Martin Smalbrugge ,
Claudia H. W. Smeets ,
Klaas van der Spek ,
Sytse U. Zuidema  and
Raymond T. C. M. Koopmans
Debby L. Gerritsen*
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands Radboudumc Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands Radboud Institute for Health Sciences, Nijmegen, the Netherlands
Erica de Vries
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
Martin Smalbrugge
Affiliation:
Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands
Claudia H. W. Smeets
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands Radboudumc Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands Radboud Institute for Health Sciences, Nijmegen, the Netherlands
Klaas van der Spek
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
Sytse U. Zuidema
Affiliation:
Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
Raymond T. C. M. Koopmans
Affiliation:
Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands Radboudumc Alzheimer Centre, Radboud University Medical Centre, Nijmegen, the Netherlands De Waalboog, Specialized Geriatric Care Centre ‘Joachim en Anna,’ Nijmegen, the Netherlands
*
Correspondence should be addressed to: Debby L. Gerritsen, Department of Primary and Community Care, Radboud University Medical Center, Code 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands. Phone: +31 24 361 95 88. Email: debby.gerritsen@radboudumc.nl.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

Before drawing conclusions on the contribution of an effective intervention to daily practice and initiating dissemination, its quality and implementation in daily practice should be optimal. The aim of this process evaluation was to study these aspects alongside a randomized controlled trial investigating the effects of a multidisciplinary biannual medication review in long-term care organizations (NTR3569).

Design:

Process evaluation with multiple measurements.

Setting:

Thirteen units for people with dementia in six long-term care organizations in the Netherlands.

Participants:

Physicians, pharmacists, and nursing staff of participating units.

Intervention:

The PROPER intervention is a structured and biannually repeated multidisciplinary medication review supported by organizational preparation and education, evaluation, and guidance.

Measurements:

Web-based questionnaires, interviews, attendance lists of education sessions, medication reviews and evaluation meetings, minutes, evaluation, and registration forms.

Results:

Participation rates in education sessions (95%), medication reviews (95%), and evaluation meetings (82%) were high. The intervention’s relevance and feasibility and applied implementation strategies were highly rated. However, the education sessions and conversations during medication reviews were too pharmacologically oriented for several nursing staff members. Identified barriers to implementation were required time, investment, planning issues, and high staff turnover; facilitators were the positive attitude of professionals toward the intervention, the support of higher management, and the appointment of a local implementation coordinator.

Conclusion:

Implementation was successful. The commitment of both higher management and professionals was an important factor. This may partly have been due to the subject being topical; Dutch long-term-care organizations are pressed to lower inappropriate psychotropic drug use.

Keywords

barriers and facilitatorsimplementation strategiesintervention qualitylong-term carenursing staffpsychoactive drugs
Type
Original Research Article
Information
International Psychogeriatrics , Volume 33 , Special Issue 9: Issue Theme: Implementation Science II , September 2021 , pp. 933 - 945
Copyright
© International Psychogeriatric Association 2019

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.)

Footnotes

*

Equal contribution

References

Appelhof, B. et al. (2018). Process evaluation of an intervention for the management of neuropsychiatric symptoms in young-onset dementia. The Journal of the American Medical Directors Association, 19, 663–671.CrossRefGoogle ScholarPubMed
Buist, Y., Verbeek, H., De Boer, B. and de Bruin, S. R. (2018). Innovating dementia care; implementing characteristics of green care farms in other long-term care settings. International Psychogeriatrics, 30, 1057–1068.10.1017/S1041610217002848CrossRefGoogle ScholarPubMed
Day, K., Kenealy, T. W. and Sheridan, N. F. (2016). Should we embed randomized controlled trials within action research: arguing from a case study of telemonitoring. BMC Medical Research Methodology, 16, 70.CrossRefGoogle ScholarPubMed
Eldridge, S., Ashby, D., Bennett, C., Wakelin, M. and Feder, G. (2008). Internal and external validity of cluster randomised trials: systematic review of recent trials. BMJ, 336, 876–880.CrossRefGoogle ScholarPubMed
Elo, S. and Kyngas, H. (2008). The qualitative content analysis process. Journal of Advanced Nursing, 62, 107–115.CrossRefGoogle ScholarPubMed
Francke, A. L., Smit, M. C., De Veer, A. J. and Mistiaen, P. (2008). Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review. BMC Medical Informatics and Decision Making, 8, 38.CrossRefGoogle ScholarPubMed
Glasgow, R. E., Klesges, L. M., Dzewaltowski, D. A., Estabrooks, P. A. and Vogt, T. M. (2006). Evaluating the impact of health promotion programs: using the RE-AIM framework to form summary measures for decision making involving complex issues. Health Education Research, 21, 688–694.CrossRefGoogle ScholarPubMed
Gustafsson, M., Karlsson, S. and Lovheim, H. (2013). Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacology and Toxicology, 14, 10.CrossRefGoogle ScholarPubMed
Hendriks, I., Meiland, F. J. M., Gerritsen, D. L. and Droes, R. M. (2018). Implementation and impact of unforgettable: an interactive art program for people with dementia and their caregivers. International Psychogeriatrics, 31, 351–362.CrossRefGoogle ScholarPubMed
Hulscher, M. E., Laurant, M. G. and Grol, R. P. (2003). Process evaluation on quality improvement interventions. Quality and Safety in Health Care, 12, 40–46.CrossRefGoogle ScholarPubMed
Janus, S. I., Van Manen, J. G., Mj, I. J. and Zuidema, S. U. (2016). Psychotropic drug prescriptions in Western European nursing homes. International Psychogeriatrics, 28, 1775–1790.CrossRefGoogle ScholarPubMed
Koopmans, R., Pellegrom, M. and Van Der Geer, E. R. (2017). The Dutch move beyond the concept of nursing home physician specialists. The Journal of the American Medical Directors Association, 18, 746–749.CrossRefGoogle ScholarPubMed
Leontjevas, R., Gerritsen, D. L., Koopmans, R. T., Smalbrugge, M. and Vernooij-Dassen, M. J. (2012). Process evaluation to explore internal and external validity of the “Act in Case of Depression” care program in nursing homes. The Journal of the American Medical Directors Association, 13, 488 e1–8.10.1016/j.jamda.2012.03.006CrossRefGoogle ScholarPubMed
Leontjevas, R., Gerritsen, D. L., Smalbrugge, M., Teerenstra, S., Vernooij-Dassen, M. J. and Koopmans, R. T. (2013). A structural multidisciplinary approach to depression management in nursing-home residents: a multicentre, stepped-wedge cluster-randomised trial. Lancet, 381, 2255–2264.CrossRefGoogle ScholarPubMed
Liberati, E. G., Gorli, M. and Scaratti, G. (2016). Invisible walls within multidisciplinary teams: disciplinary boundaries and their effects on integrated care. Social Science & Medicine, 150, 31–39.CrossRefGoogle ScholarPubMed
Loi, S. M., Mazur, A., Huppert, D., Hoy, B., Swan, J. and Lautenschlager, N. T. (2017). A pilot study using “apps” as a novel strategy for the management of challenging behaviors seen in people living in residential care. International Psychogeriatrics, 29, 637–643.10.1017/S1041610216002039CrossRefGoogle ScholarPubMed
Lucas, J. A. et al. (2014). Antipsychotic medication use in nursing homes: a proposed measure of quality. International Journal of Geriatric Psychiatry, 29, 1049–1061.10.1002/gps.4098CrossRefGoogle ScholarPubMed
Mentes, J. C. and Tripp-Reimer, T. (2002). Barriers and facilitators in nursing home intervention research. Western Journal of Nursing Research, 24, 918–936.CrossRefGoogle ScholarPubMed
Resnick, B. (2013). Interdisciplinary interventions and teams are good…can we move beyond that? The Journal of the American Medical Directors Association, 14, 456–458.CrossRefGoogle Scholar
Rosemond, C. A., Hanson, L. C., Ennett, S. T., Schenck, A. P. and Weiner, B. J. (2012). Implementing person-centered care in nursing homes. Health Care Management Review, 37, 257–266.CrossRefGoogle ScholarPubMed
Rothwell, P. M. (2005). External validity of randomised controlled trials: “to whom do the results of this trial apply?” Lancet, 365, 82–93.10.1016/S0140-6736(04)17670-8CrossRefGoogle Scholar
Seitz, D. P. et al. (2013). Pharmacological treatments for neuropsychiatric symptoms of dementia in long-term care: a systematic review. International Psychogeriatrics, 25, 185–203.CrossRefGoogle ScholarPubMed
Sharkey, S., Hudak, S., Horn, S. D., Barrett, R., Spector, W. and Limcangco, R. (2013). Exploratory study of nursing home factors associated with successful implementation of clinical decision support tools for pressure ulcer prevention. Advances in Skin & Wound Care, 26, 83–92; quiz p 93–94.CrossRefGoogle ScholarPubMed
Smeets, C. H. et al. (2013). Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial. BMC Psychiatry, 13, 280.CrossRefGoogle ScholarPubMed
Smeets, C. H. W. et al. (2017). Psychotropic drug prescription for nursing home residents with dementia: prevalence and associations with non-resident-related factors. Aging and Mental Health, 22, 1239–1246.Google ScholarPubMed
Steckler, A. B. and Linnan, L. (2002). Process Evaluation for Public Health Interventions and Research. San Francisco, CA: Jossey-Bass.Google Scholar
Tjia, J., Mazor, K. M., Field, T., Meterko, V., Spenard, A. and Gurwitz, J. H. (2009). Nurse-physician communication in the long-term care setting: perceived barriers and impact on patient safety. Journal of Patient Safety, 5, 145–152.CrossRefGoogle ScholarPubMed
Tropea, J., Logiudice, D., Liew, D., Roberts, C. and Brand, C. (2017). Caring for people with dementia in hospital: findings from a survey to identify barriers and facilitators to implementing best practice dementia care. International Psychogeriatrics, 29, 467–474.CrossRefGoogle ScholarPubMed
Van Beek, A. P. and Gerritsen, D. L. (2010). The relationship between organizational culture of nursing staff and quality of care for residents with dementia: questionnaire surveys and systematic observations in nursing homes. International Journal of Nursing Studies, 47, 1274–1282.CrossRefGoogle ScholarPubMed
Van Der Spek, K. et al. (2016). Only 10% of the psychotropic drug use for neuropsychiatric symptoms in patients with dementia is fully appropriate. The PROPER I-study. International Psychogeriatric, 28, 1589–1595.CrossRefGoogle ScholarPubMed
Van Der Spek, K. et al. (2018). The effect of biannual medication reviews on the appropriateness of psychotropic drug use for neuropsychiatric symptoms in patients with dementia: a randomised controlled trial. Age and Ageing, 47, 430–437.CrossRefGoogle ScholarPubMed
Van Mierlo, L. D. et al. (2018). Facilitators and barriers to adaptive implementation of the Meeting Centers Support Program (MCSP) in three European countries; the process evaluation within the MEETINGDEM study. International Psychogeriatrics, 30, 527–537.CrossRefGoogle ScholarPubMed
Verkaik, R., Francke, A. L., Van Meijel, B., Ouwerkerk, J., Ribbe, M. W. and Bensing, J. M. (2011). Introducing a nursing guideline on depression in dementia: a multiple case study on influencing factors. International Journal of Nursing Studies, 48, 1129–1139.CrossRefGoogle ScholarPubMed
Zwijsen, S. A., Smalbrugge, M., Eefsting, J. A., Gerritsen, D. L., Hertogh, C. M. and Pot, A. M. (2014a). Grip on challenging behavior: process evaluation of the implementation of a care program. Trials, 15, 302.CrossRefGoogle ScholarPubMed
Zwijsen, S. A. et al. (2014b). Coming to grips with challenging behavior: a cluster randomized controlled trial on the effects of a multidisciplinary care program for challenging behavior in dementia. The Journal of the American Medical Directors Association, 15, 531 e1–10.CrossRefGoogle ScholarPubMed
Supplementary material: File

Gerritsen et al. supplementary material

Gerritsen et al. supplementary material
Download Gerritsen et al. supplementary material(File)
File 13.5 KB