The Effect of Educational Intervention on Use of Psychotropics in Defined Daily Doses and Related Costs - a Randomized Controlled Trial

Overview

Journal Scand J Prim Health Care

Specialty Public Health

Date 2022 May 12

PMID 35546060

Authors

Aalto Ulla L

Rantsi Mervi

Juola Anna-Liisa

Kautiainen Hannu

Pitkala Kaisu H

Affiliations

Soon will be listed here.

Abstract

Objective: To investigate the effect of an educational intervention of nursing staff on change in psychotropic use and related costs among older long-term care residents.

Design: A secondary analysis of a randomized controlled intervention study with 12 months of follow-up.

Setting: Assisted living facilities in Helsinki, Finland.

Subjects: Older (≥65 years) residents ( = 227) living in assisted living facility wards ( = 20) in Helsinki in 2011.

Intervention: The wards were randomized into two groups. In one group, the nursing staff received training on appropriate medication therapy and guidance to recognize potentially harmful medications and adverse effects (intervention group); in the other group, the nursing staff did not receive any additional training (control group).

Main Outcome Measures: Change of psychotropic use counted as relative proportions of WHO ATC-defined daily doses (rDDDs) among older long-term care residents. In addition, the change in drug costs was considered. Comparable assessments were performed at 0, 6, and 12 months.

Results: A significant decrease in both rDDDs and the cost of psychotropics was observed in the intervention group at 6 months follow-up. However, at 12 months, the difference between the intervention and control group had diminished.

Conclusions: Educational training can be effective in reducing the doses and costs of psychotropics. Further studies are warranted to investigate whether long-term effects can also be achieved by various educational interventions.

Registration Number: ACTRN 12611001078943 KEY POINTSWe explored the effect of staff training on psychotropic use and associated costs among older long-term care residents.Educational training of nursing staff was beneficial as regards the actual drug doses of psychotropics, and cost savings in psychotropic medication were achieved.Educational training was efficient in the short-term, but further research is warranted to achieve long-term effects.

References

Tampi R, Tampi D, Balachandran S, Srinivasan S . Antipsychotic use in dementia: a systematic review of benefits and risks from meta-analyses. Ther Adv Chronic Dis. 2016; 7(5):229-45. PMC: 4994396. DOI: 10.1177/2040622316658463. View

Liperoti R, Sganga F, Landi F, Topinkova E, Denkinger M, van der Roest H . Antipsychotic Drug Interactions and Mortality Among Nursing Home Residents With Cognitive Impairment. J Clin Psychiatry. 2017; 78(1):e76-e82. DOI: 10.4088/JCP.15m10303. View

Hyttinen V, Jyrkka J, Valtonen H . A Systematic Review of the Impact of Potentially Inappropriate Medication on Health Care Utilization and Costs Among Older Adults. Med Care. 2016; 54(10):950-64. DOI: 10.1097/MLR.0000000000000587. View

Guigoz Y, Lauque S, Vellas B . Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med. 2003; 18(4):737-57. DOI: 10.1016/s0749-0690(02)00059-9. View

Janus S, van Manen J, IJzerman M, Zuidema S . Psychotropic drug prescriptions in Western European nursing homes. Int Psychogeriatr. 2016; 28(11):1775-1790. DOI: 10.1017/S1041610216001150. View

Harrison S, Cations M, Jessop T, Hilmer S, Sawan M, Brodaty H . Approaches to Deprescribing Psychotropic Medications for Changed Behaviours in Long-Term Care Residents Living with Dementia. Drugs Aging. 2018; 36(2):125-136. DOI: 10.1007/s40266-018-0623-6. View

Seppala L, Wermelink A, de Vries M, Ploegmakers K, van de Glind E, Daams J . Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: II. Psychotropics. J Am Med Dir Assoc. 2018; 19(4):371.e11-371.e17. DOI: 10.1016/j.jamda.2017.12.098. View

. American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2019; 67(4):674-694. DOI: 10.1111/jgs.15767. View

You J, Singer D, Howard P, Lane D, Eckman M, Fang M . Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e531S-e575S. PMC: 3278056. DOI: 10.1378/chest.11-2304. View

10.

Wauters M, Elseviers M, Peeters L, De Meester D, Christiaens T, Petrovic M . Reducing Psychotropic Drug Use in Nursing Homes in Belgium: An Implementation Study for the Roll-Out of a Practice Improvement Initiative. Drugs Aging. 2019; 36(8):769-780. DOI: 10.1007/s40266-019-00686-5. View

11.

Sterke C, van Beeck E, Van der Velde N, Ziere G, Petrovic M, Looman C . New insights: dose-response relationship between psychotropic drugs and falls: a study in nursing home residents with dementia. J Clin Pharmacol. 2011; 52(6):947-55. DOI: 10.1177/0091270011405665. View

12.

Fog A, Kvalvaag G, Engedal K, Straand J . Drug-related problems and changes in drug utilization after medication reviews in nursing homes in Oslo, Norway. Scand J Prim Health Care. 2017; 35(4):329-335. PMC: 5730030. DOI: 10.1080/02813432.2017.1397246. View

13.

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

14.

Jester D, Molinari V, Zgibor J, Volicer L . Prevalence of psychotropic polypharmacy in nursing home residents with dementia: a meta-analysis. Int Psychogeriatr. 2021; 33(10):1083-1098. DOI: 10.1017/S1041610220004032. View

15.

Hill-Taylor B, Sketris I, Hayden J, Byrne S, OSullivan D, Christie R . Application of the STOPP/START criteria: a systematic review of the prevalence of potentially inappropriate prescribing in older adults, and evidence of clinical, humanistic and economic impact. J Clin Pharm Ther. 2013; 38(5):360-72. DOI: 10.1111/jcpt.12059. View

16.

Massot Mesquida M, Tristany Casas M, Franzi Siso A, Garcia Munoz I, Vian O, Toran Monserrat P . Consensus and evidence-based medication review to optimize and potentially reduce psychotropic drug prescription in institutionalized dementia patients. BMC Geriatr. 2019; 19(1):7. PMC: 6323667. DOI: 10.1186/s12877-018-1015-9. View

17.

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

18.

Foebel A, Liperoti R, Onder G, Finne-Soveri H, Henrard J, Lukas A . Use of antipsychotic drugs among residents with dementia in European long-term care facilities: results from the SHELTER study. J Am Med Dir Assoc. 2014; 15(12):911-7. DOI: 10.1016/j.jamda.2014.07.012. View

19.

Pitkala K, Juola A, Kautiainen H, Soini H, Finne-Soveri U, Bell J . Education to reduce potentially harmful medication use among residents of assisted living facilities: a randomized controlled trial. J Am Med Dir Assoc. 2014; 15(12):892-8. DOI: 10.1016/j.jamda.2014.04.002. View

20.

Roitto H, Kautiainen H, Aalto U, Ohman H, Laurila J, Pitkala K . Fourteen-Year Trends in the Use of Psychotropic Medications, Opioids, and Other Sedatives Among Institutionalized Older People in Helsinki, Finland. J Am Med Dir Assoc. 2019; 20(3):305-311. DOI: 10.1016/j.jamda.2018.12.022. View