Impact of a geriatric intervention conducted in nursing homes on inappropriate prescriptions of antipsychotics
Key Summary Points
To examine the added value of a geriatrician intervention in a nursing home (NH) engaged in an 18-month quality assurance exercise on the potentially inappropriate prescription of antipsychotics (PIPA), compared to straightforward nursing home audit feedback.
Our study showed that the intervention, including collaborative work meetings between a geriatrician and NH staff, had no effects on PIPA. However, we found that feedback from each NH quality assurance audit had a substantial impact, reducing PIPA by more than 20% in the two study groups.
The involvement of the NH in a quality assurance approach and the high rate of antipsychotic prescriptions highlighted in a quality assurance audit lead to improvements in the level and quality of antipsychotic prescriptions.
To study the effect of a quality assurance approach in a nursing home, with or without the intervention of a geriatrician, on the potentially inappropriate prescription of antipsychotics (PIPA) at 18 months; and to identify the factors associated with PIPA after 18 months of intervention (T18).
We used data from a multicentre individually tailored controlled trial (IQUARE study). The study population comprised residents included in the IQUARE study with at least one potentially inappropriate prescription of antipsychotics at baseline (T0) who were still in nursing home at T18 (n = 636; nursing homes = 175). The control group received individual feedback from the quality assurance audit performed at baseline. The intervention group also had at least 5 collaborative work meetings with a geriatrician over an 18-month period. We used a multilevel logistic regression model.
The rates of inappropriate antipsychotic drug prescribing were 66.5% and 45.2% at T0 and T18, respectively. This decrease in the rate of PIPA is significant (p < 0.001). A significant decrease was found within each group: in the intervention arm (68.1% at T0 vs. 44.6% at T18; p < 0.001) and in the control arm (65.2% at T0 vs. 45.6% at T18; p < 0.001). Multivariate analysis did not highlight any statistically significant association between living in a nursing home having received an intervention and PIPA at T18.
Collaborative work meetings with a geriatrician does not provide significant added value to a global quality assurance approach towards PIPA. Individual feedback to each nursing home appears to have a substantial impact on decreasing PIPA.
KeywordsNursing homes Inappropriate prescribing Antipsychotics Older persons Intervention
CLdM and YR had full access to all of the study data and assume responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: YR. Acquisition of data: YR. Analysis and interpretation of data: All authors. Critical revision of the manuscript for important intellectual content: All authors. Drafting of the manuscript: All authors. Statistical analysis: CLdM, ML-M and PdSB. Final approval of the version to be published: All authors.
The IQUARE study was funded by a grant from the Regional Health Agency of the Midi-Pyrénées region (Agence Régionale de Santé—Midi-Pyrénées). This work was carried out as part of the doctoral research of Clarisse Laffon de Mazières, who received research fellowship funding (Allocation Jeunes Chercheurs 2012—Toulouse University Hospital).
Compliance with ethical standards
Conflict of interest
The authors have reported no conflict of interest.
To develop the IQUARE study, we followed the principles of the Declaration of Helsinki and complied with ethical standards in France. The trial protocol was approved by the Toulouse University Hospital Ethics Committee and the Consultative Committee for Treatment of Research Information on Health (CNIL: 07-438).
The consent of each residents was obtained by an information leaflet delivered at each resident included in the study, their family and general practitioner. If the residents or their family or the general practitioner refused to participate, the residents was exclued to the study.
The funder contributed to data collection. The funder had no influence on the analysis and interpretation of data, or on the preparation, review, or approval of the manuscript.
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