Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Mar 29:11:45.
doi: 10.1186/s13012-016-0410-x.

Appropriate prescribing in nursing homes demonstration project (APDP) study protocol: pragmatic, cluster-randomized trial and mixed methods process evaluation of an Ontario policy-maker initiative to improve appropriate prescribing of antipsychotics

Laura Desveaux  1 , Tara Gomes  2   3   4 , Mina Tadrous  4 , Lianne Jeffs  2 , Monica Taljaard  5   6 , Jess Rogers  7 , Chaim M Bell  8 , Noah M Ivers  9   10   11
Affiliations
Randomized Controlled Trial

Appropriate prescribing in nursing homes demonstration project (APDP) study protocol: pragmatic, cluster-randomized trial and mixed methods process evaluation of an Ontario policy-maker initiative to improve appropriate prescribing of antipsychotics

Laura Desveaux et al. Implement Sci. .

Abstract

Background: Antipsychotic medications are routinely prescribed in nursing homes to address the behavioral and psychological symptoms of dementia. Unfortunately, inappropriate prescribing of antipsychotic medications is common and associated with increased morbidity, adverse drug events, and hospitalizations. Multifaceted interventions can achieve a 12-20 % reduction in antipsychotic prescribing levels in nursing homes. Effective interventions have featured educational outreach and ongoing performance feedback.

Methods/design: This pragmatic, cluster-randomized control trial and embedded process evaluation seeks to determine the effect of adding academic detailing to audit and feedback on prescribing of antipsychotic medications in nursing homes, compared with audit and feedback alone. Nursing homes within pre-determined regions of Ontario, Canada, are eligible if they express an interest in the intervention. The academic detailing intervention will be delivered by registered health professionals following an intensive training program including relevant clinical issues and techniques to support health professional behavior change. Physicians in both groups will have the opportunity to access confidential reports summarizing their prescribing patterns for antipsychotics in comparison to the local and provincial average. Participating homes will be allocated to one of the two arms of the study (active/full intervention versus standard audit and feedback) in two waves, with a 2:1 allocation ratio. Homes will be randomized after stratifying for geography, baseline antipsychotic prescription rates, and size, to ensure a balance of characteristics. The primary outcome is antipsychotic dispensing in nursing homes, measured 6 months after allocation; secondary outcomes include clinical outcomes and healthcare utilization.

Discussion: Policy-makers and the public have taken note that antipsychotics are used in nursing homes in Ontario far more than other jurisdictions. Academic detailing can be an effective technique to address challenges in appropriate prescribing in nursing homes, but effect sizes vary widely. This opportunistic, policy-driven evaluation, embedded within a government-initiated demonstration project, was designed to ensure policy-makers receive the best evidence possible regarding whether and how to scale up the intervention.

Trial registration: ClinicalTrials.gov NLM Identifier: NCT02604056 .

Keywords: Academic detailing; Antipsychotic medication; Inappropriate prescribing; Nursing home; Randomized trials.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Flow of participants
See this image and copyright information in PMC

References

    1. Loganathan M, Singh S, Franklin BD, Bottle A, Majeed A. Interventions to optimise prescribing in care homes: systematic review. Age Ageing. 2011;40(2):150–162. doi: 10.1093/ageing/afq161. - DOI - PubMed
    1. Beers MH, Ouslander JG, Fingold SF, et al. Inappropriate medication prescribing in skilled-nursing facilities. Ann Intern Med. 1992;117(8):684–689. doi: 10.7326/0003-4819-117-8-684. - DOI - PubMed
    1. Garcia-Gollarte F, Baleriola-Julvez J, Ferrero-Lopez I, Cuenllas-Diaz A, Cruz-Jentoft AJ. An educational intervention on drug use in nursing homes improves health outcomes resource utilization and reduces inappropriate drug prescription. J Am Med Dir Assoc. 2014;15(12):885–891. doi: 10.1016/j.jamda.2014.04.010. - DOI - PubMed
    1. Rochon PA, Stukel TA, Bronskill SE, et al. Variation in nursing home antipsychotic prescribing rates. Arch Intern Med. 2007;167(7):676–683. doi: 10.1001/archinte.167.7.676. - DOI - PubMed
    1. Thompson Coon J, Abbott R, Rogers M, et al. Interventions to reduce inappropriate prescribing of antipsychotic medications in people with dementia resident in care homes: a systematic review. J Am Med Dir Assoc. 2014;15(10):706–718. doi: 10.1016/j.jamda.2014.06.012. - DOI - PubMed

Publication types

Associated data