Abstract
Background: Antipsychotics are commonly prescribed to people living with dementia in nursing home settings, despite strong guideline recommendations against their use except in limited circumstances. We aimed to transparently describe the development process for a complex intervention targeting appropriate requesting and prescribing of antipsychotics to nursing home residents with dementia in Ireland, by nurses and general practitioners (GPs) respectively. Methods: We report the development process for the 'Rationalising Antipsychotic Prescribing in Dementia' (RAPID) complex intervention, in accordance with the 'Guidance for reporting intervention development studies in health research' (GUIDED) checklist. The UK Medical Research Council framework for developing and evaluating complex interventions guided our overall approach, incorporating evidence and theory into the intervention development process. To unpack the intervention development process in greater detail, we followed the Behaviour Change Wheel approach. Guided by our stakeholders, we conducted three sequential studies (systematic review and qualitative evidence synthesis, primary qualitative study and expert consensus study), to inform the intervention development. Results: The RAPID complex intervention was developed in collaboration with a broad range of stakeholders, including people living with dementia and family carers, between 2015 and 2017. The finalised RAPID complex intervention was comprised of the following three components; 1) Education and training sessions with nursing home staff; 2) Academic detailing with GPs; 3) Introduction of an assessment tool to the nursing home. Conclusions: This paper describes the steps used by the researchers to develop a complex intervention targeting antipsychotic prescribing to nursing home residents with dementia in Ireland, according to the GUIDED checklist. We found that the GUIDED checklist provided a useful way of reporting all elements in a cohesive manner and complemented the other tools and frameworks used. Transparency in the intervention development processes can help in the translation of evidence into practice.
Highlights
Antipsychotics are a class of medication that are principally used for the treatment of schizophrenia and other psychotic disorders, including bipolar affective disorder[1]
While some reductions in antipsychotic prescribing to people living with dementia have been observed in recent years at a country level[12,13,14], there is evidence emerging that the coronavirus disease 2019 (COVID-19) pandemic, which disproportionately affects nursing home residents with dementia, is associated with a significant rise in antipsychotic prescribing[15,16]
While the main target within the nursing home setting were nurses given their role in medication management, we considered that involving others that work in nursing homes may be an important way of restructuring the social environment and promoting behaviour change[19]
Summary
Antipsychotics are a class of medication that are principally used for the treatment of schizophrenia and other psychotic disorders, including bipolar affective disorder[1]. They are frequently used in people living with dementia, especially in nursing home settings, to treat the so-called ‘behavioural and psychological symptoms of dementia’ (BPSD)[2,3], despite modest evidence of effectiveness and significant evidence of harms[4,5,6]. Antipsychotics are commonly prescribed to people living with dementia in nursing home settings, despite strong guideline recommendations against their use except in limited circumstances. Results: The RAPID complex intervention was developed in Invited Reviewers version 1
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