The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD).

Carmelle Peisah,Henry Brodaty,Julie-Anne Strukovski,Rosalind Mulholland,Georgina Luscombe,Chanaka Wijeratne

doi:10.1017/s1041610214002816

Abstract

Behavioral and psychological symptoms of dementia (BPSD) are virtually ubiquitous in dementia. Excessive recourse to use of psychotropics which have high risk to benefit ratio remains a global problem. We aimed to identify components of quality prescribing in BPSD to develop a tool for quality prescribing and to test this tool. We used Delphi methodology to identify elements of quality prescribing in BPSD. The tool was tested by a range of medical and nursing professionals on 48 patients, in inpatient and ambulatory settings in Northern Sydney Local Health District, Australia. Consensual opinion using Delphi method was that quality prescribing in dementia comprised ten factors including failure to use first line non-pharmacological strategies, indication, choice of drug, consent, dosage, mode of administration, titration, polypharmacy, toxicity, and review. These elements formed the quality use of medications in dementia (QUM-D) tool, lower scores of which reflected quality prescribing, with a possible range of scores from 0 to 30. When inter-rater reliability was tested on a subgroup of raters, QUM-D showed high inter-rater reliability. A significant reduction in QUM-D scores was demonstrated from baseline to follow-up, mean difference being 5.3 (SD = 3.8; 95% confidence interval 4.1-6.4; t = 9.5; df = 47; p < 0.001). There was also a significant reduction in score from baseline to follow-up when rated by clinical nurse consultants from a specialized behavior assessment management service (BAMS) (N = 12). The QUM-D is a tool which may help to improve quality prescribing practices in the context of BPSD. In this setting, we consider quality prescribing, and accordingly the obligations of prescribers, to be an inclusive concept rather than just adding to the mantra of "not prescribing."

Highlights

Behavioral and psychological symptoms of dementia (BPSD) (Burns et al, 2012) occur so commonly as to be virtually ubiquitous in this disease (Brodaty et al, 2001)
We aimed to: (i) identify, using expert opinion, the components of quality prescribing in dementia and BPSD; (ii) use this expert opinion to develop a tool for education and quality prescribing in dementia; (iii) test this tool; and in particular, (iv) test its efficacy when used by clinical nurse consultants from a specialized Behavior Assessment Management Service (BAMS)
We used the Delphi method to identify the elements of quality prescribing in dementia and BPSD

Summary

Introduction

BPSD (Burns et al, 2012) occur so commonly as to be virtually ubiquitous in this disease (Brodaty et al, 2001). Reliance on medications to “manage” these symptoms occurs commonly and is increasing, at least in Australia. Of residents were being prescribed psychotropic medications in 2009, an increase of 19% compared with an earlier audit in 2003 (Snowdon et al, 2011). This rate varies (Hyojeong and Whall, 2006; Rochon et al, 2007) depending on whether all nursing home residents are sampled or only those with dementia, of whom 75% were prescribed psychotropics in one study (Selbaek et al, 2007). We aimed to identify components of quality prescribing in BPSD to develop a tool for quality prescribing and to test this tool

Objectives

Methods

Results

Conclusion