Optimizing Prescribing of Antipsychotics in Long-Term Care (OPAL): A Randomized Trial to Reduce Inappropriate Antipsychotic Prescribing in Long-Term Care
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Queen's University
- Primary Endpoint
- Percentage of long-term care residents receiving any antipsychotic without a diagnosis of psychosis
Study Overview
Brief Summary
Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in LTC. A multi component intervention to reduce inappropriate antipsychotic prescribing was evaluated in ten Canadian long-term care facilities.
Detailed Description
Increasing numbers of older adults are affected by dementia, and many will eventually reside in long-term care (LTC), where antipsychotic use is relatively common. Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in LTC but limited evidence exists on the most effective strategies for reducing inappropriate antipsychotic use.
The objective of the study was to evaluate a multicomponent approach to reduce inappropriate prescribing of antipsychotics in LTC.
A prospective, randomized stepped-wedge, study design was used to evaluate the effect of the intervention in 10 LTC facilities in Canada. The intervention consisted of an educational in-service, provision of evidence-based tools to assess and monitor neuropsychiatric symptoms (NPS) and monthly interprofessional team meetings.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Sequential
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 60 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Diagnosis of dementia
- •Receiving an antipsychotic medication without a diagnosis of psychosis
Exclusion Criteria
- •Diagnoses of schizophrenia, Huntington's disease
- •Presence of active hallucinations and/or delusions
- •Individuals at end of live or receiving palliative care
Outcomes
Primary Outcomes
Percentage of long-term care residents receiving any antipsychotic without a diagnosis of psychosis
Time Frame: 12-months
The proportion of long-term care residents receiving any antipsychotic without a diagnosis of psychosis is a quality indicator is used by the Canadian Institute for Health Information to determine potentially inappropriate antipsychotic use. The quality indicator is calculated using information routinely collected on Resident Assessment Index-Minimum Dataset (RAI-MDS) assessments by determining the number of individuals who received antipsychotics on one of more days in the 7 days preceding index (RAI-MDS item O4a ≥ 1). Individuals with schizophrenia, Huntington's disease, hallucinations, delusions, those with a limited life expectancy and those currently receiving palliative care are excluded from the numerator and denominator of this indicator.
Secondary Outcomes
- Worsening of behavioral symptoms(12-months)
- Use of physical restraints(12-months)
- Depression: Proportion of residents whose mood from symptoms of depression worsened(12-months)
- Falls: Proportion of residents experiencing a fall in the 30 day(12-months)
- Pain: Proportion of residents who had pain(12-months)
Investigators
Dr. Dallas Seitz
Principal Investigator, Associate Professor, Dept. of Psychiatry, Queen's University
Queen's University