An effective approach to reduce antipsychotic and benzodiazepine use in aged care homes: The RedUSe project

Psychotropic medications are often prescribed in aged care homes to manage old age mental health conditions. Antipsychotic drugs are used to treat behavioural and psychological symptoms of dementia (BPSD), in spite of limited efficacy and increased mortality and stroke risk. Benzodiazepines are prescribed to treat anxiety and sleep disturbance despite uncertain long-term benefit, dependence concerns, and increased falls risk. An international review of recent studies of psychotropic utilisation in aged care homes reported that two thirds of use was inappropriate. To evaluate a multi-faceted, interdisciplinary intervention to reduce the use of antipsychotics and benzodiazepines in aged care homes: the 'RedUSe' (Reducing Use of Sedatives) project. The RedUSe project was a controlled trial conducted in 25 aged care homes in Tasmania. A series of pharmacist-led, 'Quality Use of Medicines' (QUM) strategies were provided to intervention homes, including two medication audit and feedback cycles, staff educational sessions and a interdisciplinary sedative review plan. Data on psychotropic use at each home was collected utilising a customised computer program at baseline, 12 weeks and 26 weeks. An average total of 1591 residents were audited for each RedUSe measurement. Over the six month trial, there was a significant reduction in the percentage of intervention home residents regularly taking benzodiazepines (31.8% to 26.9%, p < 0.005) and antipsychotics (20.3% to 18.6%, p = 0.047), whereas control home antipsychotic and benzodiazepine use did not alter. For residents taking benzodiazepines and antipsychotics at baseline, there were also significantly more dose reductions/cessations in intervention homes than in control homes (benzodiazepines: 39.6% vs. 17.6%, p < 0.0001; antipsychotics: 36.9% vs. 20.9%, p = 0.006). Pharmacist and nursing staff participants reported a high degree of satisfaction with the project. 'RedUSe' led to a significant reduction in the proportion of residents in aged care homes taking benzodiazepines and antipsychotics, and a significant increase in the number of dose reductions/cessations of these agents. Our findings suggest that QUM strategies coordinated through community pharmacies, and incorporating the dissemination of local data on medication use, offer an effective approach to reduce psychotropic use in aged care homes.