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RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities

Citation

Westbury, JL and Gee, P and Ling, T and Brown, DT and Franks, KH and Bindoff, I and Bindoff, A and Peterson, GM, RedUSe: reducing antipsychotic and benzodiazepine prescribing in residential aged care facilities, Medical Journal of Australia, 208, (9) pp. 398-403. ISSN 0025-729X (2018) [Refereed Article]

Copyright Statement

Copyright 2018 AMPCo Pty Ltd. Produced with Elsevier B.V. All rights reserved.

DOI: doi:10.5694/mja17.00857

Abstract

Objective: To assess the impact of a multi-strategic, interdisciplinary intervention on antipsychotic and benzodiazepine prescribing in residential aged care facilities (RACFs).

Design, setting: Prospective, longitudinal intervention in Australian RACFs, April 2014 e March 2016.

Participants: 150 RACFs (with 12 157 residents) comprised the main participant group; two further groups were consultant pharmacists (staff education) and community pharmacies (prescribing data). Data for all RACF residents, excluding residents receiving respite or end-stage palliative care, were included.

Intervention: A multi-strategic program comprising psychotropic medication audit and feedback, staff education, and interdisciplinary case review at baseline and 3 months; final audit at 6 months.

Main outcome measure: Mean prevalence of regular antipsychotic and benzodiazepine prescribing at baseline, and at 3 and 6 months. Secondary measures: chlorpromazine and diazepam equivalent doses/day/resident; proportions of residents for whom drug was ceased or the dose reduced; prevalence of antidepressant and prn (as required) psychotropic prescribing (to detect any substitution practice).

Results: During the 6-month intervention, the proportion of residents prescribed antipsychotics declined by 13% (from 21.6% [95% CI, 20.4e22.9%] to 18.9% [95% CI, 17.7e20.1%]), and that of residents regularly prescribed benzodiazepines by 21% (from 22.2% [95% CI, 21.0e23.5%] to 17.6% [95% CI, 16.5 e18.7]; each, P < 0.001). Mean chlorpromazine equivalent dose declined from 22.9 mg/resident/day (95% CI, 19.8e26.0) to 20.2 mg/resident/day (95% CI, 17.5e22.9; P < 0.001); mean diazepam equivalent dose declined from 1.4 mg/resident/day (95% CI, 1.3e1.5) to 1.1 mg/resident/day (95% CI, 0.9e1.2; P < 0.001). For 39% of residents prescribed antipsychotics and benzodiazepines at baseline, these agents had been ceased or their doses reduced by 6 months. There was no substitution by sedating antidepressants or prn prescribing of other psychotropic agents.

Conclusions: The RedUSe program achieved significant reductions in the proportions of RACF residents prescribed antipsychotics and benzodiazepines.

Item Details

Item Type:Refereed Article
Keywords:psychotropic, intervention, antipsychotics and benzodiazepines, nursing homes
Research Division:Medical and Health Sciences
Research Group:Public Health and Health Services
Research Field:Public Health and Health Services not elsewhere classified
Objective Division:Health
Objective Group:Specific Population Health (excl. Indigenous Health)
Objective Field:Health Related to Ageing
UTAS Author:Westbury, JL (Dr Juanita Breen)
UTAS Author:Gee, P (Mr Peter Gee)
UTAS Author:Ling, T (Dr Tristan Ling)
UTAS Author:Brown, DT (Ms Donnamay Brown)
UTAS Author:Franks, KH (Miss Katherine Franks)
UTAS Author:Bindoff, I (Dr Ivan Bindoff)
UTAS Author:Bindoff, A (Mr Aidan Bindoff)
UTAS Author:Peterson, GM (Professor Gregory Peterson)
ID Code:126056
Year Published:2018
Web of Science® Times Cited:6
Deposited By:Wicking Dementia Research and Education Centre
Deposited On:2018-05-21
Last Modified:2018-12-13
Downloads:0

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