PROPER I: frequency and appropriateness of psychotropic drugs use in nursing home patients and its associations: a study protocol

BMC Psychiatry

Raymond TCM Koopmans¹  Sytse U Zuidema³  Claudia HW Smeets¹  Roland B Wetzels¹  Marjorie HJMG Nelissen-Vrancken²  Martin Smalbrugge⁴  Debby L Gerritsen¹  Klaas van der Spek¹ 

[1] Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, Huispost 117 ELG, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands;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, PO Box 196, 9700 AD Groningen, 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: Environment;    Psychotropic drug use;    Neuropsychiatric symptoms;    Dementia;    Nursing home;   

Others  :  1123889
DOI  :  10.1186/1471-244X-13-307

 received in 2013-10-18, accepted in 2013-11-13,  发布年份 2013

【 摘 要 】

Background

Nursing home patients with dementia use psychotropic drugs longer and more frequently than recommended by guidelines implying psychotropic drugs are not always prescribed appropriately. These drugs can have many side effects and effectiveness is limited. Psychotropic drug use between nursing home units varies and is not solely related to the severity of neuropsychiatric symptoms. There is growing evidence indicating that psychotropic drug use is associated with environmental factors, suggesting that the prescription of psychotropic drugs is not only related to (objective) patient factors. However, other factors related to the patient, elderly care physician, nurse and the physical environment are only partially identified. Using a mixed method of qualitative and quantitative research, this study aims to understand the nature of psychotropic drug use and its underlying factors by identifying: 1) frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms in nursing home patients with dementia, 2) factors associated with (appropriateness of) psychotropic drug use.

Methods

A cross-sectional mixed methods study. For the quantitative study, patients with dementia (n = 540), nursing staff and elderly care physicians of 36 Dementia Special Care Units of 12 nursing homes throughout the Netherlands will be recruited. Six nursing homes with high average rates and six with low average rates of psychotropic drug use, based on a national survey about frequency of psychotropic drug use on units, will be included. Psychotropic drugs include antipsychotics, anxiolytics, hypnotics, antidepressants, anticonvulsants and anti-dementia drugs. Appropriateness will be measured by an instrument based on the Medication Appropriateness Index and current guidelines for treatment of neuropsychiatric symptoms. Factors associated to psychotropic drug use, related to the patient, elderly care physician, nurse and physical environment, will be explored using multilevel regression analyses. For the qualitative study, in depth interviews with staff will be held and analyzed to identify and explore other unknown factors.

Discussion

This study will provide insight into factors that are associated with the frequency and appropriateness of psychotropic drug use for neuropsychiatric symptoms. Understanding psychotropic drug use and its associations may contribute to better dementia care.

【 授权许可】

   
2013 van der Spek et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Health Council of the Netherlands: Dementia. The Hague: Health Council of the Netherlands; 2002. publication no. 2002/04
• [2]Hoe vaak komt dementie voor en hoeveel mensen sterven eraan? Volksgezondheid Toekomst Verkenning. http://www.nationaalkompas.nl/gezondheid-en-ziekte/ziekten-en-aandoeningen/psychische-stoornissen/dementie/omvang/ webcite
• [3]Zuidema SU, Derksen E, Verhey FRJ, Koopmans RTCM: Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementia. Int J Geriatr Psychiatry 2007, 22:632-638.
• [4]Cornegé-Blokland E, Kleijer BC, Hertogh CMPM, van Marum RJ: Reasons to prescribe antipsychotics for the behavioral symptoms of dementia: a survey in Dutch nursing homes among physicians, nurses, and family caregivers. J Am Med Dir Assoc 2010, 13:1-7.
• [5]Wood-Mitchell A, James IA, Waterworth A, Swann A, Ballard C: Factors influencing the prescribing of medications by old age psychiatrists for behavioural and psychological symptoms of dementia: a qualitative study. Age Ageing 2008, 37:547-552.
• [6]Nijk RM, Zuidema SU, Koopmans RTCM: Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. International Psychogeriatrics / IPA 2009, 21:485-493.
• [7]Enmarker I, Olsen R, Hellzen O: Management of person with dementia with aggressive and violent behaviour: a systematic literature review. Int J Older People Nurs 2011, 6:153-162.
• [8]Selbaek G, Kirkevold Ø, Engedal K: The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes. Int J Geriatr Psychiatry 2007, 22:843-849.
• [9]Wetzels RB, Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM: Prescribing pattern of psychotropic drugs in nursing home residents with dementia. International Psychogeriatrics / IPA 2011, 23:1249-1259.
• [10]Feng Z, Hirdes JP, Smith TF, Finne-soveri H, Chi I, Du Pasquier J, Gilgen R, Ikegami N, Mor V: Use of physical restraints and antipsychotic medications in nursing homes: a cross-national study. Int J Geriatr Psychiatry 2008, 2009:1110-1118.
• [11]Testad I, Auer S, Mittelman M, Ballard C, Fossey J, Donabauer Y, Aarsland D: Nursing home structure and association with agitation and use of psychotropic drugs in nursing home residents in three countries: Norway, Austria and England. Int J Geriatr Psychiatry 2010, 25:725-731.
• [12]Nygaard HA, Brudvik E, Juvik OB, Pedersen WE, Rotevatn TS, Vollset A: Consumption of psychotropic-drugs in nursing-home residents - a prospective-study in patients permanently admitted to a nursing-home. Int J Geriatr Psychiatry 1994, 9:387-391.
• [13]Van Iersel MB, Zuidema SU, Koopmans RT, Verhey FR: ORM: antipsychotics for behavioural and psychological problems in elderly people with dementia: a systematic review of adverse events. Drugs Aging 2005, 22:845-858.
• [14]Schneider LS, Dagerman KIP: Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry 2006, 14:191-210.
• [15]Ballard C, Hanney ML, Theodoulou M, Douglas S, McShane R, Kossakowski K, Gill R, Juszczak E, Yu L-M, Jacoby R: The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol 2009, 8:151-157.
• [16]Uzun S, Kozumplik O, Jakovljevic M, Sedic B: Side effects of treatment with benzodiazepines. Psychiatr Danub 2010, 22:90-93.
• [17]Wetzels RB, Zuidema SU, De Jonghe JFM, Verhey FRJ, Koopmans RTCM: Determinants of quality of life in nursing home residents with dementia. Dement Geriatr Cogn Disord 2010, 29:189-197.
• [18]Ballard C, OBrien J, James I, Mynt P, Lana M, Potkins D, Reichelt K, Lee L, Swann A, Fossey J: Quality of Life for People With Dementia Living in Residential and Nursing Home Care: The Impact of Performance on Activities of Daily Living, Behavioral and Psychological Symptoms, Language Skills, and Psychotropic Drugs. Int Psychogeriatr 2001, 13:93-106.
• [19]Gustafsson M, Karlsson S, Lövheim H: Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units. BMC Pharmacol Toxicol 2013, 14:10. BioMed Central Full Text
• [20]Van Dijk KN, de Vries CS, van den Berg PB, et al.: Drug utilisation in Dutch nursing homes. Eur J Clin Pharmacol 2000, 55:765-771.
• [21]Zuidema SU, De Jonghe JFM, Verhey FRJ, Koopmans RTCM: Neuropsychiatric symptoms in nursing home patients: factor structure invariance of the Dutch nursing home version of the neuropsychiatric inventory in different stages of dementia. Dement Geriatr Cogn Disord 2007, 24:169-176.
• [22]Bustin J: Atypical antipsychotics and CATIE-AD. Is this a turning point? Vertex 2009, 20:136-143.
• [23]Smalbrugge M, Boersma F, Kleijer BC, Kok RM, Sival RC, Verburg D, Verheij FRJ, Zuidema SU: Guideline problem behavior, NVVA. 2008.
• [24]Chen Y, Briesacher BA, Field TS, Tjia J, Lau DT, Gurwitz JH: Unexplained variation across US nursing homes in antipsychotic prescribing rates. Arch Intern Med 2010, 170:89-95.
• [25]Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM: Psychotropic drug prescription in nursing home patients with dementia: influence of environmental correlates and staff distress on physicians’ prescription behavior. Int Psychogeriatr 2011, 23:1-8.
• [26]Zuidema SU, de Jonghe JFM, Verhey FRJ, Koopmans RTCM: Environmental correlates of neuropsychiatric symptoms in nursing home patients with dementia. Int J Geriatr Psychiatry 2010, 25:14-22.
• [27]Kamble P, Chen H, Sherer JT, Aparasu RR: Use of antipsychotics among elderly nursing home residents with dementia in the US: an analysis of National Survey Data. Drugs Aging 2009, 26:483-492.
• [28]Smeets CH, Smalbrugge M, Gerritsen DL, Nelissen-Vrancken MH, Wetzels RB, van der Spek K, Zuidema SU, Koopmans RT: Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial. BMC Psychiatry 2013, 13(1):280. BioMed Central Full Text
• [29]Nordic Council on Medicines: Guidelines for ATC classification. Oslo: WHO Collaborating Center for Drugs Statistics Methodology; 1990.
• [30]Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, Cohen HJ, Feussner JR: A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992, 45:1045-1051.
• [31]Luo R, Scullin C, Mullan AMP, Scott MG, McElnay JC: Comparison of tools for the assessment of inappropriate prescribing in hospitalized older people. J Eval Clin Pract 2011, 18:1-7.
• [32]Stuijt CCM, Franssen EJF, Egberts ACG, Hudson SA: Appropriateness of prescribing among elderly patients in a Dutch residential home: observational study of outcomes after a pharmacist-led medication review. Drugs Aging 2008, 25:947-954.
• [33]KNMP kennisbank. http://kennisbank.knmp.nl/index.asp#homenl webcite
• [34]Farmacotherapeutisch kompas. http://www.fk.cvz.nl/ webcite
• [35]Medicines Evaluation Board(MEB). http://www.cbg-meb.nl/cbg/en/default.htm webcite
• [36]Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, Lopez OL, DeKosky ST: Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. J Neuropsychiatry Clin Neurosci 2000, 12:233-239.
• [37]de Jonghe JF, Kat MG, Kalisvaart CJ: Neuropsychiatric inventory questionnaire (NPI-Q): A validity study of the Dutch form. Tijdschr Gerontol Geriatr 2003, 34:74-77.
• [38]Cohen-Mansfield J, Billig N: Agitated behaviors in the elderly I. A conceptual review. J Am Geriatr Soc 1986, 34:711-721.
• [39]Zuidema SU, Buursema AL, Gerritsen MGJM, Oosterwal KC, Smits MMM, Koopmans RTCM, de Jonghe JFM: Assessing neuropsychiatric symptoms in nursing home patients with dementia: reliability and reliable change index of the neuropsychiatric inventory and the cohen-mansfield agitation inventory. Int J Geriatr Psychiatry 2011, 26:127-134.
• [40]Zuidema SU, Derksen E, Verhey FRJ, Koopmans RTCM: Prevalence and predictors of neuropsychiatric symptoms in cognitively impaired nursing home patients. J Geriatr Psychiatry Neurol 2007, 20:632-638.
• [41]Lintern T: Quality in Dementia Care: Evaluating Staff Attitudes and Behaviour. 20th edition. University of Wales Bangor; 2001:15-16.
• [42]Scott-Cawiezell J, Jones K, Moore L, Vojir C: Nursing home culture: a critical component in sustained improvement. J Nurs Care Qual 2005, 20:341-348.
• [43]Van Beek APA, Gerritsen DL: The relationship between organizational culture of nursing staff and quality of care for residents with dementia: questionnaire surveys and systematic observations in nursing homes. Int J Nurs Stud 2010, 47:1274-1282.
• [44]Cameron KFS: Culture, congruence, strenght and type: relationship to effectiveness. Res Org Change Dev 1991, 5:23-58.
• [45]de Jonge J, Landeweerd JA: Toetsing van de Job Demand-Control benadering bij werknemers Demand-Control, in de gezondheidszorg: een secundaire data-analyse [Testing of the Job approach among health care workers: a secondary analysis]. Gedrag en Organisatie 1993, 6:79-92.
• [46]Vermaat K: Flexibele werklastbeheersing in de verpleging[Flexible workload control in nursing]. Maastricht: Universty of Limburg; 1994.
• [47]Landeweerd JA, Boumans NPG, Nissen JMF: Arbeidsvoldoening bij verplegenden en verzorgenden. De Maastrichtse arbeidssatisfactieschaal voor de gezondheidszorg. [Job satisfaction of nurses and CNAs. The Maastricht Work Satisfaction Scale for Healthcare]. In Handboek Verpleegkundige Innovatie. Edited by Van Beek CC, Van Dorsten TG, Stam GJ. Houten: Bohn Stafleu; 1996.
• [48]Sloane PD, Mitchell CM, Weisman G, Zimmerman S, Foley KML, Lynn M, Calkins M, Lawton MP, Teresi J, Grant L, Lindeman D, Montgomery R: The Therapeutic Environment Screening Survey for Nursing Homes (TESS-NH): an observational instrument for assessing the physical environment of institutional settings for persons with dementia. J Gerontol B Psychol Sci Soc Sci 2002, 57:S69-S78.
• [49]Cooney A: Choosing between Glaser and Strauss: an example. Nurse Res 2010, 17:18-28.
• [50]Strauss A, Corbin J: Basics of Qualitative Research. 3rd edition. Sage: Thousand Oaks, CA; 2008:379.
• [51]Strauss ACJ: Basics of qualitative research; Grounded theory procedures and techniques. London: Sage; 1990.
• [52]Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR: A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996, 49:1373-1379.
• [53]Peduzzi P, Concato J, Feinstein AR, Holford TR: Importance of Events Per Independent Variable in Proportional Hazards Regression Analysis. II. Accuracy and Precision of Regression Estimates. J Clin Epidemiol 1995, 48:1503-1510.