Inappropriate Prescribing Of Antipsychotics Research Articles

Association Between Long-Term Care Facility Staffing Levels and Antipsychotic Use in US Long-Term Care Facilities.

Inappropriate use of antipsychotics is an indicator of quality of care in long-term care (LTC) facilities. There is evidence to suggest that staffing levels in LTC may be associated with the rates of inappropriate antipsychotic use. This study sought to examine the association between staffing and antipsychotic prescribing in LTC facilities. Cross-sectional study investigated the association between reported staffing levels and the frequency of inappropriate antipsychotic prescribing at US LTC facilities between 2016 and2018. Data from the Nursing Home Compare and LTCFocus datasets were linked, which contain information from the Minimum Data Set database on facility characteristics and staffing measures from the Payroll-Based Journal system. A final sample set of 10,436 facilities was used. Descriptive statistics were calculated for all variables of interest. An unadjusted linear correlation analysis and linear regression were performed. Potential confounders were investigated by comparison across low-vs high-staffing facilities where adjusted for in regression analyses. The mean staff level for the facilities was identified as 3.69 (SD= 0.67) staffing hours per patient per day, and the mean antipsychotic use rate across all facilities was 15.24% (SD= 8.62%). There was a 0.75% decrease in inappropriate antipsychotic prescribing per unit increase in overall staff-to-patient ratio. When looking at staffing types, a 3.09% decrease in inappropriate antipsychotic prescribing was observed per unit increase in licensed staff hours. More specifically, we saw a 2.25% decrease per unit increase in RN staffing hours, a 1.83% decrease per unit increase in LPN staffing hours, and nursing aide staffing hours were not associated with antipsychotic use. These findings provide support for policy-based interventions to decrease antipsychotic use in LTC facilities by improving staffing skill mix and staffing levels. The results may also inform nursing staff education and training on antipsychotic prescribing practices.

Rationalising Antipsychotic Prescribing in Dementia (RAPID) complex intervention: A mixed-methods feasibility intervention study

BackgroundTo help address the issue of inappropriate antipsychotic prescribing to nursing home residents with dementia, the ‘Rationalising Antipsychotic Prescribing in Dementia’ (RAPID) complex intervention was developed, comprising staff education and training, academic detailing and a novel resident assessment tool. ObjectivesThe primary objective was to assess the feasibility and acceptability of the RAPID complex intervention in a nursing home setting. The secondary objective was to describe associated trends in psychotropic prescribing, falls, and behavioural symptoms. MethodsA mixed-methods feasibility intervention study in one large nursing home in Ireland was undertaken between 07/2017 and 01/2018. Focus groups and semi-structured interviews were conducted with nursing home staff and GPs at the end of the 3-month follow up period to assess participants' experience of the intervention. Quantitative measurements included pre- and post-course evaluation and psychotropic prescribing rates. ResultsSixteen nursing home staff members attended the two education and training days (21% attendance rate), and four GPs participated in the academic detailing sessions (100% attendance rate). Participants of the focus groups and interviews (n = 18) found the education and training beneficial for their work and expressed a desire to continue educating new staff after the study's completion. However, there was limited usage of the resident assessment tool. Participants also offered recommendations to enhance the intervention.The proportion of dementia residents prescribed at least one regular antipsychotic was stable over the 3-months pre-intervention at 45% (n = 18), and at baseline at 44% (n = 19) but decreased slightly to 36% (n = 14) at 3-months post-intervention. At the same time the absolute number of ‘PRN’ psychotropics administered monthly to dementia residents decreased substantially from 90 at baseline to 69 at 3-months post-intervention. ConclusionThe RAPID complex intervention was broadly feasible to conduct and may be acceptable to stakeholders. However, before it can be evaluated in larger scale studies, certain protocol modifications and further exploratory work are required to improve implementation.

Antipsychotic and Psychotropic Prescribing in Assisted Living

The Center for Medicare & Medicaid Services has brought national attention to potentially inappropriate antipsychotic prescribing for residents with dementia in nursing homes, but no such attention has been paid to prescribing in assisted living (AL), despite the fact that more than 40% of AL residents have moderate/severe dementia. This study examined antipsychotic and other psychotropic prescribing in AL using a seven-state sample of 250 communities, and examined correlates of prescribing; analyses used weights based on probability proportional to bed size to derive state-level estimates. Overall, 19% of residents were taking an antipsychotic medication (27% of those with dementia); corresponding numbers for antidepressants were 46% (54%) and for anxiolytics/hypnotics were 24% (28%; both p <.001). By way of example, communities that did not have an RN or LPN were more likely to prescribe antipsychotics (34% vs. 17%; p<.001). The discussion will highlight next steps regarding practice, policy, and research.

Initiation of antipsychotics after moving to residential aged care facilities and mortality: a national cohort study

BackgroundThere is a high burden of antipsychotic use in residential aged care facilities (RACFs) and there is concern regarding potential inappropriate prescribing of antipsychotics in response to mild behavioural symptoms. Antipsychotic use has been associated with a higher risk of mortality in community-dwelling older adults with dementia, but few studies have examined associations upon RACF entry.AimsTo examine associations between incident antipsychotic use and risk of mortality for people with and without diagnosed dementia in RACFs.MethodsA retrospective cohort study, employing a new-user design (individuals did not receive an antipsychotic 6 months before enrolment) of 265,820 people who accessed RACFs in Australia between 1/4/2008 and 30/6/2015 was conducted. Cox regression models were used to examine adjusted associations between antipsychotic use in the first 100 days of RACF entry and mortality.ResultsIn the 100 days after entering care, 29,455 residents (11.1%) were dispensed an antipsychotic. 180,956 (68.1%) residents died [38,249 (14.4%) were related to cerebrovascular causes] over a median 2.1 years (interquartile range 1.0–3.6) follow-up. Of the residents included, 119,665 (45.0%) had a diagnosis of dementia. Incident antipsychotic use was associated with higher risk of mortality in residents with dementia (adjusted hazard ratio 1.20, 95% confidence interval 1.18–1.22) and without dementia (1.28, 1.24–1.31).ConclusionInitiation of antipsychotics after moving to RACFs is associated with a higher risk of mortality. Careful consideration of the potential benefits and harms should be given when starting a new prescription for antipsychotics for people moving to RACFs.

Optimizing Prescribing of Antipsychotics in Long-Term Care (OPAL): A Stepped-Wedge Trial

BackgroundInappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in long-term care (LTC), but limited evidence exists on the most effective strategies for reducing inappropriate antipsychotic use. ObjectivesThe objective of the study was to evaluate a multicomponent approach to reduce inappropriate prescribing of antipsychotics in LTC. DesignA prospective, stepped-wedge study design was used to evaluate the effect of the intervention. Settings and participantsInterdisciplinary staff at 10 Canadian LTC facilities. MethodsThe intervention consisted of an educational in-service, provision of evidence-based tools to assess and monitor neuropsychiatric symptoms (NPS) in dementia, and monthly interprofessional team meetings. The primary outcome was the proportion of residents receiving an antipsychotic without a diagnosis of psychosis using a standardized antipsychotic quality indicator. ResultsThe weighted mean change in inappropriate antipsychotic prescribing rate from baseline to 12-month follow-up was −4.6% [standard deviation (SD) = 2.8%, P < .0001], representing a 16.1% (SD = 17.0) relative reduction. After adjusting for site, the odds ratio for the inappropriate antipsychotic prescribing quality indicator at 12 months compared to baseline was 0.73 (95% confidence interval = 0.48-0.94; chi-square = 6.59; P = .01). There were no significant changes in related quality indicators, including falls, restraint use, or behavioral symptoms. Conclusions and implicationsThis multicomponent intervention was effective in reducing inappropriate antipsychotic prescribing in LTC without adversely affecting other domains related to quality of care, and offers a practical means by which to improve the care of older adults with dementia in LTC.

A retrospective comparison of inappropriate prescribing of psychotropics in three Norwegian nursing homes in 2000 and 2016 with prescribing quality indicators

BackgroundInappropriate prescribing of psychotropics is a persistent and prevalent problem in nursing homes. The present study compared inappropriate prescribing of psychotropics in nursing homes 16 years apart with prescribing quality indicators. The purpose was to identify any change in inappropriate prescribing of relevance for medical informatics.MethodsThree Norwegian nursing homes were audited in 2000 and 2016 with regard to prescribing quality. Psychotropics among 386 patients in 2000, and 416 patients in 2016, included combinations of antidepressants, antipsychotics, anxiolytics-hypnotics, and antiepileptics. Prescribing quality indicators included psychotropic polypharmacy (defined as concurrent use of three or more psychotropics) and potential inappropriate psychotropic substances or combinations. Furthermore, potential clinically relevant psychotropic interactions were classified as pharmacodynamic or pharmacokinetic using an interaction database. The first ranked (most important) interaction in each patient was selected with the following importance of categories in the database; recommended action > documentation > severity. Three levels (from low to high) within each category were used for ranking.ResultsFrom 2000 to 2016, psychotropic polypharmacy increased from 6.2 to 29.6%, potential inappropriate psychotropic substances was reduced from 17.9 to 11.3% and potential inappropriate psychotropic combinations increased from 7.8 to 27.9%. Changes in polypharmacy and combinations were predominantly associated with prescribing of anxiolytics-hypnotics. Sixty-three patients (16.3%) had psychotropic interactions in 2000 increasing to 146 patients (35.1%) in 2016. The increase in interactions was associated with prescribing of antidepressants. First ranked interactions, more than 60% of all interactions in both years, were increasingly pharmacodynamic, from 69.9 to 91.0%. Interactions in 2016 were associated with a lower level of recommended action and documentation, but not severity compared to 2000. The inappropriate prescribing of antipsychotics and antiepileptics was reduced in 2016 compared to 2000.ConclusionsUsing prescribing quality indicators we observed the importance of antidepressants and anxiolytics-hypnotics for inappropriate prescribing in 2016 while the role of antipsychotics and antiepileptics were reduced compared to 2000. A change to mainly pharmacodynamic interactions that lack good documentation was also observed. The present findings can be used for medical informatics-based approaches to address specific problems with prescribing, and prescribing quality indicators, in Norwegian nursing homes.

The health professional experience of using antipsychotic medication for dementia in care homes: A study using grounded theory and focussing on inappropriate prescribing.

People with dementia can experience symptoms that upset them and upset the people who care for them To cope, care homes sometimes use strong medicines called antipsychotics but these can make people with dementia become more ill We do not know just why doctors and nurses caring for people with dementia still use these strong medicines more than they need to WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Giving antipsychotics can make it easier to care for residents within busy care homes, so people tend to see and remember the benefits of antipsychotics The harm of antipsychotics is noticed less, meaning carers will use them again, in a "vicious circle" WHAT ARE THE IMPLICATIONS FOR PRACTICE: If these medicines worked before it does not make them the right choice again It might help to show carers very clearly the harms from using these medicines, to stress the dangers ABSTRACT: Introduction Treating the behavioural and psychological symptoms of dementia with antipsychotics can cause detrimental side-effects but their use in care homes remains problematic with the views of professionals not fully explored. To develop an in-depth explanatory model about inappropriate prescribing of antipsychotics in dementia within care homes. Twenty-eight participants from eight different professional groups with a role in shaping treatment decisions in dementia care were recruited and interviewed. The audio-recorded interviews were transcribed and analyzed using constructivist grounded theory. When patients with dementia present with behavioural and psychological symptoms, the prescribing of antipsychotics allows the multitude of work in a care home to be managed; the effectiveness of antipsychotics is more perceptible than their side-effects. This perceived usefulness strengthens beliefs that these medications ought to be prescribed again in future situations, generating a self-fulfilling prophecy. Our findings may partly explain why the launch of the national dementia strategy in England has been found not to have reduced antipsychotic prescribing in care homes. Positive perceptions based on past experiences with antipsychotics should be challenged through future interventions that tackle inappropriate prescribing, for example using behaviour change techniques to better highlight adverse consequences of prescribing.

Increased All-Cause Mortality by Antipsychotic Drugs: Updated Review and Meta-Analysis in Dementia and General Mental Health Care.

It is almost ten years since the Banerjee 2009 report established that inappropriate prescribing of antipsychotics in the elderly was occurring in the UK and such patients had an 85% increased risk of adverse events and greater mortality. This report was a critical analysis addressing the outcomes of treatment practices for dementia in UK patients and globally, aimed at reducing prescribing of antipsychotic drugs for dementia. Since 2009, many significant studies worldwide (including several more recent large retrospective studies) provide more extensive longitudinal data for the adverse impacts of antipsychotic drugs in dementia. We have used the data in these studies including from over 380,000 dementia patients, with 85,069 prescribed antipsychotic agents as well as from 359,235 non-dementia antipsychotic drug users to provide an up-dated meta-analysis. This is the first meta-analysis to include evidence from general mental health studies showing that antipsychotic drugs precipitate excessive mortality across the spectrum. Prescribing of antipsychotic drugs for dementia or for other mental health care should be avoided and alternative means sought for handling behavioral disorders of such patients.

Reducing anti-psychotic prescribing for care home residents with dementia

This article reports on the outcome and evaluation of the focused intervention training and support (FITS) into practice programme, a training and support programme for care home staff aimed at reducing inappropriate anti-psychotic prescribing for people living with dementia by implementing alternative psychosocial interventions. This programme was adapted from an original randomised-controlled trial that successfully reduced the prescribing of anti-psychotic medications in care homes. The aim of the new programme was to replicate the impact of the original trial, but using a less resource-intense model, so that it could be implemented across care homes in the UK within existing resource conditions. The programme successfully reduced anti-psychotic prescribing and improved staff knowledge and attitudes. Barriers and facilitators of implementation were identified at four key levels: the dementia care coach; the care home; the organisation; and external relationships. Crucial to success was the provision of dedicated time for dementia care coaches to implement, the ongoing support provided by the expert-practitioner role, and the quality of relationships with prescribers. The implications of these for the FITS into practice programme, other similar interventions, and the work of prescribers with care homes are discussed.

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

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.

FITS into practice: translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes

Objectives: This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes. Method: An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs). Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation. Results: Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes. Discussion and conclusions: The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation.

Improving antipsychotic prescribing practices in nursing facilities: The role of surveyor methods and surveying agencies in upholding the Nursing Home Reform Act.

Inappropriate prescribing of antipsychotics is a longstanding challenge to providing high quality care in nursing facilities. The 1987 Nursing Home Reform Act (NHRA) had an initial impact in reducing inappropriate prescribing, but rates returned to pre-NHRA levels. While the recent Partnership to Improve Dementia Care in Nursing Homes (Partnership) initiative has been successful in reducing the prescribing of antipsychotics in skilled nursing facilities/nursing facilities (NF), it is not known how this guidance initiative impacted prescribing practices and other care processes concerning NF residents with dementia. The objectives of this study were to explore surveyor observations of NF care practices subsequent to participation the Partnership guidance program and to use a social ecological framework to estimate how these observations were influenced by individual, organizational, and contextual factors. A total of 320 NF surveyors responded to a 49-item questionnaire designed in collaboration with CMS officials and state surveying agency personnel, and distributed by state agency directors. Three outcome variables: measuring improvements in clinical care, deficiencies in clinical care, and falsification of records in response to the Partnership initiative, were created from survey responses. A four-level social ecological framework describing the NF surveyor's environment was used to identify potential influences on surveyors' care observations. Logistic regression was used to evaluate the relationship between environment and outcome variables. Surveyors observed both improvements in clinical care, including 80.6% reporting nursing facility providers responding to consultant pharmacists' recommendations, and deficits in clinical care in response to the Partnership initiative. Furthermore, 39.7% of surveyors observed a new, but false, diagnosis of psychosis (as defined by the surveyor). Surveyor characteristics and methods and surveying agency and culture were found to substantially impact the success of the Partnership initiative. The most distal level of the framework evaluated in this study, state contextual effects, was found not to impact care observations. There is substantial variation in surveyor observations of changes to clinical care in response to the Partnership guidance initiative. Further investigation is needed into the type and severity of falsification of records observed by nursing facility surveyors. When constructing interventions to care for residents in NFs, policymakers must consider the environment in which surveyors operate.

Toolbox: Management of behavioral and psychological symptoms of dementia

While antipsychotics have been used to treat psychosis or aggressive behaviors in dementia populations, they appear to have a high side effect profile that leads to high discontinuation rates.1 Additionally, antipsychotics, as a class, carry a black box warning for use in the dementia population. Both CMS and APA have announced initiatives over the past two years to reduce the inappropriate prescribing of antipsychotics in order to manage BPSD. Mood stabilizers may be considered as an alternative to neuroleptics. This table presents data on the efficacy of mood stabilizing drugs for the management of BPSD.

PREVALENCE AND CORRELATES OF PSEUDOBULBAR AFFECT (PBA) SYMPTOMS IN NURSING HOME RESIDENTS

Background: Reduction of antipsychotic medication use in nursing homes is a government mandate in the United States (U.S.). Recent U.S. studies have reported a high prevalence of potentially inappropriate prescribing of antipsychotics among patients with dementia in nursing homes. In addition to therapy for psychosis, these medicines are also used for management of disruptive behaviors such as inappropriate crying, laughing, and anger. These symptoms may be manifestations of pseudobulbar affect (PBA). Prevalence of PBA among nursing home residents with dementia is unknown; among noninstitutionalized adults with dementia, published prevalence of PBA symptoms ranges from 10% to 39%. Methods: This patient screen/chart review included all residents (N1⁄4811) of a convenience sample of 9 nursing homes in Michigan. Data were collected in the subset of 418 residents who met inclusion criteria (having a neurological diagnosis) and excluded those with a diagnosis of psychosis. Clinical assessments included the Center for Neurologic StudyâV’Lability Scale (CNS-LS; a research tool for assessment of PBA symptoms), a PBA diagnostic checklist, and extraction of predetermined items from each resident’s most recent Minimum Data Set (3.0) assessment. The presence of PBA symptoms was defined as a CNS-LS score 13. Results: Of eligible residents, 74 met the CNS-LS threshold for PBA symptoms (17.7%), yielding a possible PBA symptom prevalence of 9.1% of all nursing home residents. Those with PBA symptoms were of similar age to those without but were more likely to be white and female. Those with CNS-LS 13 had higher rates of depression and anxiety as well as higher likelihood of receiving psychotropic medications. The 9 Michigan nursing homes studied were similar to the national average in size and level of regulatory compliance; the studied nursing homes were more likely to be for-profit chain facilities and had larger proportions of Medicaid recipients and residents with dementia than the national averages. Conclusions: In this study, almost 1 in 10 nursing home residents, and 17.7% of those with neurological disorders, displayed symptoms of PBA, a disorder for which antipsychotic medications are not FDA approved. Greater awareness, diagnosis, and treatment of PBA may help reduce indiscriminate use of antipsychotics for nursing home residents with dementia.

A Serious Risk: Excessive and Inappropriate Antipsychotic Prescribing

A Serious Risk: Excessive and Inappropriate Antipsychotic Prescribing

Use of Antipsychotics Among Older Residents in VA Nursing Homes

Antipsychotic medications are commonly prescribed to nursing home residents despite their well-established adverse event profiles. Because little is known about their use in Veterans Affairs (VA) nursing homes [ie, Community Living Centers (CLCs)], we assessed the prevalence and risk factors for antipsychotic use in older residents of VA CLCs. This cross-sectional study included 3692 Veterans age 65 or older who were admitted between January 2004 and June 2005 to one of 133 VA CLCs and had a stay of ≥90 days. We used VA Pharmacy Benefits Management data to examine antipsychotic use and VA Medical SAS datasets and the Minimum Data Set to identify evidence-based indications for antipsychotic use (eg, schizophrenia, dementia with psychosis). We used multivariable logistic regression and generalized estimating equations to identify factors independently associated with antipsychotic receipt. Overall, 948/3692(25.7%) residents received an antipsychotic, of which 59.3% had an evidence-based indication for use. Residents with aggressive behavior [odds ratio (OR)=2.74, 95% confidence interval (CI), 2.04-3.67] and polypharmacy (9+ drugs; OR=1.84, 95% CI, 1.41-2.40) were more likely to receive antipsychotics, as were users of antidepressants (OR=1.37, 95% CI, 1.14-1.66), anxiolytic/hypnotics (OR=2.30, 95% CI, 1.64-3.23), or drugs for dementia (OR=1.52, 95% CI, 1.21-1.92). Those residing in Alzheimer/dementia special care units were also more likely to receive an antipsychotic (OR=1.66, 95% CI, 1.26-2.21). Veterans with dementia but no documented psychosis were as likely as those with an evidence-based indication to receive an antipsychotic (OR=1.10, 95% CI, 0.82-1.47). Antipsychotic use is common among VA nursing home residents aged 65 and older, including those without a documented evidence-based indication for use. Further quality improvement efforts are needed to reduce potentially inappropriate antipsychotic prescribing.

Assessment of antipsychotic prescribing in Belgian nursing homes

Given the potential adverse effects of antipsychotics, high use in nursing homes creates concern. Our study goal was to explore the use of antipsychotics in relation to resident characteristics, and to assess the appropriateness of antipsychotic prescribing in Belgian nursing homes. Data were used from a cross-sectional study (Prescribing in Homes for the Elderly; PHEBE) conducted in 76 nursing homes in Belgium. Antipsychotics were classified into typical and atypical, using the anatomical therapeutic and chemical classification. Ten inappropriate antipsychotic prescribing indicators were selected from the updated Beers criteria (2003), Bergen District Nursing Home Study (BEDNURS) indicators, and Screening Tool of Older People's Prescriptions criteria (STOPP). The residents' mean age was 84.8 years, 78.1% of whom were female. The prevalence of antipsychotic utilization was 32.9%. Antipsychotics were mainly indicated for dementia-related agitation, and psychosis with/without dementia. Higher use of antipsychotics was found for dementia (OR: 3.27; 95% CI: 2.61-4.09), insomnia (OR: 1.38; 95% CI: 1.10-1.73), depression (OR: 1.30; 95% CI: 1.03-1.65), and age <80 years (OR: 1.79; 95% CI: 1.38-2.33). Inappropriate antipsychotic prescribing indicators scoring the highest among users were: long-term use (92.6%), use despite risk of falling (45.6%), combined use with other psychotropics (31.8%), and duplicate use (15.1%). Inappropriate prescribing was associated with depression (OR: 3.41) and insomnia (OR: 2.17). The indicator-driven analysis of antipsychotic prescribing quality revealed a need for improvement, with the main prescribing problems relating to duration and combination of therapies. Risks/benefits of off-label use need to be evaluated more consciously at the start of therapy, and at periodic re-evaluations.

Inappropriate antipsychotic prescribing in Italy?

Inappropriate antipsychotic prescribing in Italy?