Collaborative Quality Improvement Efforts Can Positively Impact Antipsychotic Use

June 24, 2020

Reducing antipsychotic use in nursing homes is an ongoing priority for clinicians and their teams. A study in the June issue of JAMDA suggests that substantial improvements in the use of these drugs may be achieved through targeted, collaborative quality improvement initiatives.

In A Canadian Cohort Study to Evaluate the Outcomes Associated with a Multicenter Initiative to Reduce Antipsychotic Use in Long-Term Care Homes, the authors provided education, training, and support to quality improvement teams at participating nursing homes in six Canadian provinces/territories. These tools were designed to help them implement localized strategies intended to reduce antipsychotic medication use in residents without a diagnosis of psychosis. Specifically, teams received training and mentoring to implement person-centered care approaches to respond to behaviors associated with dementia, improve methods for staff collaboration, and enhance medication review procedures with a focus on antipsychotic use.

The authors observed a pronounced impact of these interventions on antipsychotic use that was independent of historical trends, provincial initiatives, and individual level risk factors. The training and support provided to teams also was associated with a substantial increase in the likelihood that these medications would be discontinued among residents without a diagnosis of psychosis or mental health symptoms. At the same time, there was no evidence that intervention facilities experienced a worsening of behavioral symptoms.

The authors concluded, “This improvement in performance was independent of secular trends toward reduced antipsychotic use in participating provinces.” This, they said, suggests that collaborative quality improvement efforts may help ensure that medications, including antipsychotics, are used appropriately in this population.

This study was conducted by researchers at the School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Canadian Foundation for Healthcare Improvement, Ottawa, Ontario, Canada; Winnipeg Regional Health Authority, Winnipeg, Canada; and Health Standards Organization, Ottawa, Ontario, Canada.

Click here for more information on the findings above and more details about the study. To contact the researchers or JAMDA editor for an interview, please email



JAMDA is the official journal of AMDA – The Society for Post-Acute and Long-Term Care Medicine. JAMDA publishes peer-reviewed articles including original studies, reviews, clinical experience articles, case reports, and more, on all topics more important to post-acute and long-term care medicine. Visit for more information.

About AMDA – The Society for Post-Acute and Long-Term Care Medicine
AMDA – The Society for Post-Acute and Long-Term Care Medicine is the only medical specialty society representing the community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants, and other practitioners working in the various post-acute and long-term care (PALTC) settings. Dedicated to defining and improving quality, we advance our mission through timely professional development, evidence-based clinical guidance, and tireless advocacy on behalf of members, patients, families, and staff. Visit for more information.