Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial

BMC Psychiatry

Raymond TCM Koopmans³  Sytse U Zuidema²  Klaas van der Spek³  Roland B Wetzels³  Marjorie HJMG Nelissen-Vrancken¹  Debby L Gerritsen³  Martin Smalbrugge⁴  Claudia HW Smeets³ 

[1] Dutch Institute for Rational Use of Medicine, P.O. Box 3089, 3502, GB Utrecht, the Netherlands;Department of General Practice, University of Groningen, University Medical Center Groningen, HPC FA21, P.O. Box 196, 9700, AD Groningen, the Netherlands;Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud university medical center, Code 117 ELG, P.O. Box 9101, 6500, HB Nijmegen, the Netherlands;Department of General Practice and Elderly Care Medicine/EMGO + Institute for Health and Care Research, VU Medical Center, P.O Box 7057, 1007, MB Amsterdam, The Netherlands

关键词: Clinical trial;    Medication safety;    Nursing homes;    Psychotropic drugs;    Dementia;   

Others  :  1123915
DOI  :  10.1186/1471-244X-13-280

 received in 2013-10-17, accepted in 2013-10-23,  发布年份 2013

【 摘 要 】

Background

Neuropsychiatric symptoms are highly prevalent in nursing home patients with dementia. Despite modest effectiveness and considerable side effects, psychotropic drugs are frequently prescribed for these neuropsychiatric symptoms. This raises questions whether psychotropic drugs are appropriately prescribed. The aim of the PROPER (PRescription Optimization of Psychotropic drugs in Elderly nuRsing home patients with dementia) II study is to investigate the efficacy of an intervention for improving the appropriateness of psychotropic drug prescription in nursing home patients with dementia.

Methods/design

The PROPER II study is a multi-center cluster randomized controlled, pragmatic trial using parallel groups. It has a duration of eighteen months and four six-monthly assessments. Six nursing homes will participate in the intervention and six will continue care as usual. The nursing homes will be located throughout the Netherlands, each participating with two dementia special care units with an average of fifteen patients per unit, resulting in 360 patients. The intervention consists of a structured and repeated multidisciplinary medication review supported by education and continuous evaluation. It is conducted by pharmacists, physicians, and nurses and consists of three components: 1) preparation and education, 2) conduct, and 3) evaluation/guidance. The primary outcome is the proportion of patients with appropriate psychotropic drug use. Secondary outcomes are the overall frequency of psychotropic drug use, neuropsychiatric symptoms, quality of life, activities of daily living, psychotropic drug side effects and adverse events (including cognition, comorbidity, and mortality). Besides, a process analysis on the intervention will be carried out.

Discussion

This study is expected to improve the appropriateness of psychotropic drug prescription for neuropsychiatric symptoms in nursing home patients with dementia by introducing a structured and repeated multidisciplinary medication review supported by education and continuous evaluation.

Trial registration

Netherlands Trial Registry (NTR): NTR3569.

【 授权许可】

   
2013 Smeets et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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