Optimizing Prescribing of Antipsychotics in Long-Term Care

Overview

Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in LTC. A multi component intervention to reduce inappropriate antipsychotic prescribing was evaluated in ten Canadian long-term care facilities.

Full Title of Study: “Optimizing Prescribing of Antipsychotics in Long-Term Care (OPAL): A Randomized Trial to Reduce Inappropriate Antipsychotic Prescribing in Long-Term Care”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Sequential Assignment
    • Primary Purpose: Treatment
    • Masking: None (Open Label)
  • Study Primary Completion Date: October 2017

Detailed Description

Increasing numbers of older adults are affected by dementia, and many will eventually reside in long-term care (LTC), where antipsychotic use is relatively common. Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in LTC but limited evidence exists on the most effective strategies for reducing inappropriate antipsychotic use. The objective of the study was to evaluate a multicomponent approach to reduce inappropriate prescribing of antipsychotics in LTC. A prospective, randomized stepped-wedge, study design was used to evaluate the effect of the intervention in 10 LTC facilities in Canada. The intervention consisted of an educational in-service, provision of evidence-based tools to assess and monitor neuropsychiatric symptoms (NPS) and monthly interprofessional team meetings.

Interventions

  • Other: Educational
    • Multi component educational intervention in long-term care

Clinical Trial Outcome Measures

Primary Measures

  • Percentage of long-term care residents receiving any antipsychotic without a diagnosis of psychosis
    • Time Frame: 12-months
    • The proportion of long-term care residents receiving any antipsychotic without a diagnosis of psychosis is a quality indicator is used by the Canadian Institute for Health Information to determine potentially inappropriate antipsychotic use. The quality indicator is calculated using information routinely collected on Resident Assessment Index-Minimum Dataset (RAI-MDS) assessments by determining the number of individuals who received antipsychotics on one of more days in the 7 days preceding index (RAI-MDS item O4a ≥ 1). Individuals with schizophrenia, Huntington’s disease, hallucinations, delusions, those with a limited life expectancy and those currently receiving palliative care are excluded from the numerator and denominator of this indicator.

Secondary Measures

  • Worsening of behavioral symptoms
    • Time Frame: 12-months
    • Proportion of residents who had one or more of the following behavioural symptoms: wandering, physically or verbally abusive, or socially inappropriate behaviours) present on their target RAI-MDS assessment than on their prior assessment.
  • Use of physical restraints
    • Time Frame: 12-months
    • Proportion of residents in daily physical restraints as of the target RAI-MDS assessment.
  • Depression: Proportion of residents whose mood from symptoms of depression worsened
    • Time Frame: 12-months
    • Proportion of residents whose mood from symptoms of depression worsened compared to the previous RAI-MDS assessment.
  • Falls: Proportion of residents experiencing a fall in the 30 day
    • Time Frame: 12-months
    • Proportion of residents experiencing a fall in the 30 days preceding the RAI-MDS assessment.
  • Pain: Proportion of residents who had pain
    • Time Frame: 12-months
    • Proportion of residents who had pain on their target RAI=MDS assessment.

Participating in This Clinical Trial

Inclusion Criteria

  • Diagnosis of dementia – Receiving an antipsychotic medication without a diagnosis of psychosis Exclusion Criteria:

  • Diagnoses of schizophrenia, Huntington's disease – Presence of active hallucinations and/or delusions – Individuals at end of live or receiving palliative care

Gender Eligibility: All

Minimum Age: 60 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Queen’s University
  • Collaborator
    • Canadian Consortium on Neurodegeneration in Aging
  • Provider of Information About this Clinical Study
    • Principal Investigator: Dr. Dallas Seitz, Principal Investigator, Associate Professor, Dept. of Psychiatry, Queen’s University – Queen’s University

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