Study: Further Policy, Institutional Support Needed to Encourage Appropriate Antipsychotic Prescribing
While practitioners use great caution when prescribing antipsychotics for nursing home (NH) residents with dementia, implementing evidence-based antipsychotic prescribing practices can be challenging. A new study in the November issue of JAMDA explored the determinants of appropriate antipsychotic prescribing for this population. The authors concluded that greater policy and institutional support is necessary to encourage and enable better prescribing decisions.
In “Exploring Antipsychotic Prescribing Behaviors in Nursing Home Residents with Dementia: A Qualitative Study,” the authors sampled 27 participants—24 practitioners and three family members—from four nursing homes involved in the care of nursing home residents with dementia. They identified nine domains as influencing appropriate antipsychotic prescribing behaviors: behavioral regulation, beliefs about capabilities, beliefs about consequences, emotion, environmental context and resources, knowledge, memory/attention/decision-processes, social influences, and social/professional role and identity.
A cross-cutting theme was the participants’ efforts to achieve a “fine balance” between the risks and benefits of antipsychotics. While no one wanted to see residents over-sedated and lacking quality of life, they also agreed on the need to protect staff, family members, and residents from potentially dangerous behaviors.
The authors suggested that they have “generated a deeper understanding of the behavioral components of antipsychotic use in NH residents with dementia, the professional interactions that occur between different stakeholders, and the determinants of implementation of best-practice guidelines.” They said that their findings highlight how employing evidence-based practices in this area continues to be challenging and that development of national clinical guidelines may be one solution.
Their findings, the authors said, “suggest that an evidence-based, standardized approach involving interdisciplinary collaboration, careful documentation, and regular review is needed to ensure the most appropriate use of both pharmacologic and nonpharmacologic interventions.” They referred to DICE (describe, investigate, create, and evaluate) as one promising model for such an approach.
The study was conducted by researchers at the School of Pharmacy, University College Cork, Cork, Ireland; the Healthcare Improvement Studies Institute, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom; the Health Behavior Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland; the School of Public Health, University College Cork, Cork, Ireland; and the Center for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland.
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.
About 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 (PA/LTC) 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.