PP24 Interventions to Reduce Inappropriate Prescribing of Antipsychotic Medications to People with Dementia Living in Residential Care: A Systematic Review
Notice bibliographique
Résumé
Background The use of antipsychotic medications in dementia is associated with increased mortality. A significant proportion of long-term antipsychotic use is believed to be inappropriate. The Department of Health National Dementia Strategy recently targeted a two-thirds reduction in antipsychotic usage. The aim of this review is to explore qualitative and quantitative literature to identify interventions that have been used to reduce inappropriate prescribing of antipsychotics and the barriers and enablers to the implementation of these interventions. Methods Potentially relevant papers were identified in the following ways i) electronic searches inMedline, PsycINFO, Embase, AMED, Social Policy and Practice including AgeInfo (OvidSp); CDSR, CENTRAL (Cochrane Library); CINAHL (EBSCOhost); British Nursing Index, AMED (NHS Evidence) and Science Citation Index and Social Science Citation Index (Web of Science) from inception to November 2012, ii) forward and backward citation chases, iii) hand searches of review papers identified in the search, iii) searching of relevant organisations’ websites. All comparative studies were included. Screening of articles for inclusion, data extraction and quality appraisal were performed by one reviewer and checked by a second with discrepancies resolved by discussion with a third if necessary. Results Eleven studies (involving staff and patients in 55 care homes) met the inclusion criteria. All reported quantitative data. Studies were conducted in the UK (n = 4), Canada (n = 2), USA (n = 2) Australia (n = 1) and Norway (n = 1). Studies were of varied design with associated quality issues. No papers in which barriers to the implementation of interventions had been studied were identified. All interventions were unique and involved the delivery of an education or training package (n = 5), the use of in-reach teams in which regular visits by psychiatrists, mental health nurses and psychologists enabled regular patient review in the care home (n = 4), audit followed by feedback and re-audit (n = 1) or regular review, education and the development of a behavioural management approach (n = 1). In all studies, the proportion of residents receiving antipsychotic medication was reduced following the intervention. Conclusion There is some evidence to suggest that simple changes to the way patients are reviewed and monitored and/or enhanced education and training can reduce the prescription rates of antipsychotics for people with dementia living in residential care. In order to guide best practice in this area, further qualitative study is required to explore the barriers and enablers to successful implementation of these interventions. Large rigorous studies with extended post-intervention data collection are also necessary to ascertain the long term impact on prescribing practices.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,040 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,010 | 0,008 |
| Bibliométrie | 0,011 | 0,011 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,003 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».