Deprescribing Strategy Shows Promise for Reducing Antipsychotic Use, Improving Quality of Life
Antipsychotic deprescribing with an innovative strategy has proven successful, according to an article in the February issue of JAMDA. The Optimizing Practices, Use, Care and Services—Antipsychotics (OPUS-AP) strategy aimed to improve the well-being of long-term care (LTC) residents with major neurocognitive disorders (MNCD) by implementing a resident-centered approach and nonpharmacologic interventions, as well as deprescribing in inappropriate indications.
The authors of Optimizing Practices, Use, Care and Services–Antipsychotics (OPUS-AP) in Long-term Care Centers in Quebec, Canada: A Strategy for Best Practices implemented an integrated effort including training, coaching, clinical tools, and evaluation of clinical practices, plus a change management strategy in 24 LTC centers in Quebec. They evaluated antipsychotic, benzodiazepine, and antidepressant prescriptions; behavioral and psychological symptoms of dementia (BPSD); and falls every 3 months for 9 months. They also conducted interdisciplinary team interviews.
Antipsychotic deprescribing was attempted in 220 of 344 residents, with complete cessation observed in 116 residents and dose reductions in 72 residents. A decrease in benzodiazepine prescriptions and improvements in Cohen-Mansfield Agitation Inventory (a 29-item scale to systematically assess agitation) scores were observed. At the same time, caregivers and clinicians alike expressed satisfaction about the improved quality of life among these residents. Based on the success of this describing effort, OPUS-AP (phase 2) is now underway in 129 LTC centers in Quebec.
“Although reducing use of antipsychotics in the long-term care setting has proven difficult over the years, international and national initiatives are starting to bear fruit,” said the authors, who noted that their results are consistent with other studies. They concluded that the first phase of OPUS-AP “showed that antipsychotic deprescribing can be achieved in a majority of LTC residents with MNCD without worsening of BPSD, with the concomitant implementation of a resident-centered approach and nonpharmacologic interventions.” This included a focus on teamwork and the use of team huddles, interdisciplinary intervention plans, antipsychotic tapering guidelines, and partnerships with residents and caregivers. Nonpharmacologic interventions were personalized to ensure meaning to each resident based on that person’s biographical history.
This study was conducted by researchers at the Faculty of Medicine and Health Sciences, Department of Social Work,, School of Social Work (Faculty of Letters and Human Sciences), University of Sherbrooke, Sherbrooke, Quebec, Canada; Research Centre on Aging, Integrated University Health and Social Services, Centre of Estrie, Sherbrooke University Hospital Centre, Sherbrooke, Quebec, Canada; Department of Psychiatry and Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada; Institut Universitaire de Geriatrie de Montreal Research Centre, Integrated University Health and Social Sciences Centre of the Centre-Sud-d-I’lie-de-Montreal, Montreal, Quebec, Canada; Quebec Knowledge Network in Integrated Primary Health Care, Quebec, Canada; University Hospital Centre, Sherbrooke, Canada; Minister of Health and Social Services, Canada; Canadian Foundation for Healthcare Improvement, Ottawa, Ontario, Canada; Residence Humanitae, Quebec, Canada; Centre of Excellence on Aging of Quebec, Integrated University Health and Social Services Centre of the National Capital, Quebec, Canada; Centre Hospitalier Universitaire de Sherbrooke Research Center, Sherbrooke, Quebec, Canada; Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; Faculty of Medicine, McGill University, Montreal Quebec Canada; and Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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 www.jamda.com for more information.
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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 www.paltc.org for more information.