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

BMC Psychiatry

Study Protocol

Martin Smalbrugge¹  Sytse U Zuidema²  Debby L Gerritsen³  Klaas van der Spek³  Roland B Wetzels³  Claudia HW Smeets³  Raymond TCM Koopmans³  Marjorie HJMG Nelissen-Vrancken⁴ 

[1] 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;Department of General Practice, University of Groningen, University Medical Center Groningen, PO Box 196, HPC FA21, 9700 AD, Groningen, The Netherlands;Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboudumc, P.O. Box 9101, Huispost 117 ELG, 6500 HB, Nijmegen, The Netherlands;Dutch Institute for Rational Use of Medicine, P.O. Box 3089, 3502 GB, Utrecht, The Netherlands;

关键词: Nursing home;    Dementia;    Neuropsychiatric symptoms;    Psychotropic drug use;    Environment;   

DOI  :  10.1186/1471-244X-13-307

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

来源: Springer

【 摘 要 】

BackgroundNursing 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.MethodsA 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.DiscussionThis 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】

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