OPTIMIZING PRESCRIBING OF ANTIPSYCHOTICS IN LONG-TERM CARE (OPAL)

Abstract

Increasing numbers of older adults are affected by dementia, and many will eventually reside in long-term care (LTC). Inappropriate antipsychotic use in this setting is common and associated with serious adverse effects. Limited evidence exists on the most effective strategies for reducing inappropriate antipsychotic prescribing. The objective of the study was to evaluate a multicomponent approach including an educational program to reduce inappropriate antipsychotic prescribing in LTC. A prospective, stepped wedge, controlled study design was used to evaluate the effect of the intervention in 10 LTC facilities in Ontario and Saskatchewan, Canada. The primary outcome was the proportion of residents receiving an antipsychotic without a diagnosis of psychosis. At baseline, the overall antipsychotic prescribing rate was 28.6% (Standard Deviation (SD) 4.3%). Data collection is ongoing; results at three months following implementation showed a relative reduction in the mean rate of inappropriate antipsychotic prescribing of 5.2% (SD 7.8%). The change was not statistically significant (P=0.06). There were no significant changes in related quality indicators, including falls, restraint use, and behavioural worsening. Preliminary study results show a trend towards lower rates of inappropriate antipsychotic prescribing. The intervention may offer a sustainable and practical means by which to improve the care of older adults in LTC.