Recherche évaluative du programme AP-STOP : AntiPsychotiques : Sensibilisation à leur bon usage pour les Troubles de compOrtement des Personnes âgées atteintes de démence
Bibliographic record
Abstract
Resume Objectif : Une campagne AP-STOP de sensibilisation a l’usage optimal des antipsychotiques pour les troubles de comportement associes a la demence a ete menee a l’Hopital de la Cite-de-la-Sante de Laval. Notre etude evalue les retombees de cette campagne sur la reevaluation de l’usage des antipsychotiques pour les patients hospitalises souffrant de troubles de comportement associes a la demence. Methodologie : Cette etude quasi experimentale s’est penchee sur le nombre de reevaluations des antipsychotiques pris par des patients hospitalises, âges de plus de 65 ans et atteints de demence. Elle a compare la proportion de patients ayant subi une reevaluation de l’usage des antipsychotiques (risperidone, quetiapine, olanzapine, haloperidol) avant et apres une campagne de sensibilisation. La campagne, qui se deroulait sur huit semaines, comportait des activites individuelles de formation continue appuyees par un outil clinique, qui s’adressaient aux cliniciens. Les criteres de reevaluation de l’antipsychotique se definissaient comme suit : suppression du medicament, reduction du dosage, tentative de suppression de l’antipsychotique ou de reduction du dosage de l’antipsychotique ou note medicale suggerant au medecin de famille de reevaluer l’antipsychotique, le tout bien explique dans le dossier medical du patient. En utilisant le modele de Cox, nous avons compare les eventualites de reevaluation de l’usage des antipsychotiques entre les deux groupes, tout en ajustant les resultats en fonction des caracteristiques des patients et de leur hospitalisation. Resultats : Nous avons evalue les dossiers medicaux de 616 patients et inclus 125 patients dans le groupe precedant la campagne et 85 patients dans celui succedant a la campagne. Le taux de reevaluation des antipsychotiques etait de 35,4 % apres la campagne, comparativement a 26,4 % avant la campagne (rapport de risque ajuste : 1,23; intervalle de confiance (IC) 95 % : 0,73–2,04). Conclusion : Cette etude ne permet pas de conclure qu’une campagne de sensibilisation ameliore l’usage des antipsychotiques pour les troubles de comportement associes a la demence en milieu hospitalier. Abstract Objective: AP-STOP, an awareness campaign on the optimal use of antipsychotics for behavioural problems related to dementia, was carried out at the Hopital Cite-de-la-Sante de Laval. This study evaluated the impact of this campaign on the use of antipsychotics for hospitalized patients with behavioural problems related to dementia. Method: This quasi-experimental study compared the proportion of inpatients, before and after the campaign, who were over the age of 65 and had dementia for which antipsychotic usage (risperidone, quetiapine, olanzapine, or haloperidol) was reevaluated. Held over an eight-week period, the campaign included a continuing education program for the clinicians, with individual training activities supported by a clinical tool. An antipsychotic was considered reevaluated if any of the following occurred: a discontinuation or an attempted discontinuation of the antipsychotic; a dosage reduction or an attempted dosage reduction of the antipsychotic; a pharmacy note documented in the patient’s medical record to reevaluate the antipsychotic. Using a Cox model, the likelihood of reevaluation was compared between the two groups, adjusting for patient characteristics and features of their hospital stay. Results: The medical records of 616 patients were examined, and 125 patients and 85 patients were included in the pre-campaign and post-campaign group, respectively. After the campaign, 35.4 % of the antipsychotics were reevaluated compared with 26.4 % before the campaign (adjusted hazard ratio: 1.23; 95 % CI: 0.73–2.04). Conclusion: This study does not permit the conclusion that an awareness campaign improves the use of antipsychotics for behavioural problems related to dementia in hospitals.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.030 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.012 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".