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A Multicomponent Intervention to Optimize Psychotropic Drug Prescription in Elderly Nursing Home Residents: An Italian Multicenter, Prospective, Pilot Study

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Abstract

Background

Older nursing home residents often have a large number of diseases and frequently require multiple medications; the high consumption of psychotropic drugs is of particular concern. The majority of residents in nursing homes suffer from dementia, and the use of psychotropic drugs in these patients is very high. Prescription for short periods of time only are usually recommended to avoid the risk of adverse drug reactions and potentially severe drug–drug interactions (DDIs).

Objectives

The aim of this multicenter, prospective study was to optimize the prescription of psychotropic drugs, according to the Beers recommendations, in a sample of older patients living in nursing homes in Italy, through a multicomponent intervention, education of general practitioners, and the use of INTERcheck.

Methods

The study was run in ten nursing homes in Northern Italy from September 2013 to May 2014 (9 months), with the voluntary participation of 14 general practitioners. Each physician was asked to enroll at least 20 consecutive unselected patients. Three educational interventions (‘ex cathedra’ presentations) were organized by the researchers involved in the project, and a fourth training session was also held on the use of INTERCheck, a Computerized Prescription Support System (CPSS) developed to optimize drug prescription for older people with multimorbidity. Drug prescription information and sociodemographic characteristics of each patient were collected at three different time points—before the educational and training sessions (T0), after 5 months (T1), and after 9 months (T2).

Results

Among the 272 patients included in the analysis, a significant reduction was observed in the mean number of drugs, and in the percentage receiving psychotropic drugs and potentially inappropriate psychotropic drugs (11.5 and 30.6 %, respectively; p < 0.0001). Patients exposed to at least one potentially severe DDI also decreased from 145 (53.3 %) at the first time point to 87 (32.0 %) at the last time point (p < 0.0001). Results were confirmed in the 181 patients for whom information regarding drug treatment was available at all time points.

Conclusions

The combination of an educational intervention and the CPSS can achieve a significant reduction in potentially inappropriate psychotropic drug use, psychotropic duplicates, and potentially severe DDIs in nursing homes.

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References

  1. Dwyer LL, Han B, Woodwell DA, et al. Polypharmacy in nursing home residents in the United States: results of the 2004 National Nursing Home Survey. Am J Geriatr Pharmacother. 2010;8:63–72.

    Article  PubMed  Google Scholar 

  2. Gallagher P, Barry P, O’Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther. 2007;32:113–21.

    Article  CAS  PubMed  Google Scholar 

  3. Ruggiero C, Dell’Aquila G, Gasperini B, et al. Potentially inappropriate drug prescriptions and risk of hospitalization among older, Italian, nursing home residents: the ULISSE project. Drugs Aging. 2010;27(9):747–58.

    Article  PubMed  Google Scholar 

  4. Selbæk 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;22:843–9.

    Article  PubMed  Google Scholar 

  5. Eggermont LH, de Vries K, Scherder EJ. Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia. Int Psychogeriatr. 2009;21(2):286–94.

    Article  PubMed  Google Scholar 

  6. Wetzels RB, Zuidema SU, de Jonghe JF, et al. Prescribing pattern of psychotropic drugs in nursing home residents with dementia. Int Psychogeriatr. 2011;23(8):1249–59.

    Article  CAS  PubMed  Google Scholar 

  7. Nijk RM, Zuidema SU, Koopmans RT. Prevalence and correlates of psychotropic drug use in Dutch nursing-home patients with dementia. Int Psychogeriatr. 2009;21(3):485–93.

    Article  PubMed  Google Scholar 

  8. Ballard CG, Gauthier S, Cummings JL, Brodaty H, et al. Management of agitation and aggression associated with Alzheimer disease. Nat Rev Neurol. 2009;5(5):245–55.

    Article  CAS  PubMed  Google Scholar 

  9. Ballard C, Corbett A, Chitramohan R, et al. Management of agitation and aggression associated with Alzheimer’s disease: controversies and possible solutions. Curr Opin Psychiatry. 2009;22(6):532–40.

    Article  PubMed  Google Scholar 

  10. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163(22):2716–24.

    Article  PubMed  Google Scholar 

  11. Weich S, Pearce HL, Croft P, et al. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. BMJ. 2014;348:g1996.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Billioti de Gage S, Moride Y, Ducruet T, et al. Benzodiazepine use and risk of Alzheimer’s disease: case–control study. BMJ. 2014;349:g5205.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Ballard C, Hanney ML, Theodoulou M, et al. The dementia antipsychotic withdrawal trial (DART-AD): long-term follow-up of a randomized placebo-controlled trial. Lancet Neurol. 2009;8(2):151–7.

    Article  CAS  PubMed  Google Scholar 

  14. Gareri P, De Fazio P, Manfredi VG, et al. Use and safety of antipsychotics in behavioral disorders in elderly people with dementia. J Clin Psychopharmacol. 2014;34(1):109–23.

    Article  CAS  PubMed  Google Scholar 

  15. Iyer S, Naganathan V, McLachlan AJ, Le Couteur DG. Medication withdrawal trials in people aged 65 years and older: a systematic review. Drugs Aging. 2008;25(12):1021–31.

    Article  PubMed  Google Scholar 

  16. van der Cammen TJM, Rajkumar C, Onder G, et al. Drug cessation in complex older adults: time for action. Age Ageing. 2014;43(1):20–5.

    Article  PubMed  Google Scholar 

  17. Declercq T, Petrovic M, Azermai M, et al. Withdrawal versus continuation of chronic antipsychotic drugs for behavioural and psychological symptoms in older people with dementia. Cochrane Database Syst Rev. 2013;3:CD007726.

    PubMed  Google Scholar 

  18. Chang CB, Chan DC. Comparison of published explicit criteria for potentially inappropriate medications in older adults. Drugs Aging. 2010;27(12):947–57.

    Article  PubMed  Google Scholar 

  19. van Dijk KN, de Vries CS, van den Berg PB, et al. Drug utilization in Dutch nursing homes. Eur J Clin Pharmacol. 2000;55(10):765–71.

    Article  PubMed  Google Scholar 

  20. Smeets CH, Smalbrugge M, Gerritsen DL, et al. Improving psychotropic drug prescription in nursing home patients with dementia: design of a cluster randomized controlled trial. BMC Psychiatry. 2013;13:280.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Aspinall SL, Zhao X, Semla TP, et al. Epidemiology of drug-disease interactions in older veteran nursing home residents. J Am Geriatr Soc. 2015;63(1):77–84.

    Article  PubMed Central  PubMed  Google Scholar 

  22. O’Connor MN, Gallagher P, O’Mahony D. Inappropriate prescribing: criteria, detection and prevention. Drugs Aging. 2012;29(6):437–52.

    Article  PubMed  Google Scholar 

  23. Ghibelli S, Marengoni A, Djade CD, et al. Prevention of inappropriate prescribing in hospitalized older patients using a computerized prescription support system (INTERcheck®). Drugs Aging. 2013;30(10):821–8.

    Article  PubMed  Google Scholar 

  24. Buostani M, Campbell N, Munger S, et al. Impact of anticholinergics on the aging brain: a review and practical application. Aging Health. 2008;4(3):311–20.

    Article  Google Scholar 

  25. Kaur S, Mitchell G, Vitetta L, et al. Interventions that can reduce inappropriate prescribing in the elderly: a systematic review. Drugs Aging. 2009;26(12):1013–28.

    Article  PubMed  Google Scholar 

  26. Patterson SM, Cadogan CA, Kerse N, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2014;(10):CD00816.

  27. Verrue CL, Petrovic M, Mehuys E, et al. Pharmacists’ interventions for optimization of medication use in nursing homes: a systematic review. Drugs Aging. 2009;26(1):37–49.

    Article  PubMed  Google Scholar 

  28. Forsetlund L, Eike MC, Gjerberg E, et al. Effect of interventions to reduce potentially inappropriate use of drugs in nursing homes: a systematic review of randomised controlled trials. BMC Geriatr. 2011;11:16.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Stuijt CC, Franssen EJ, Egberts AC, et al. 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(11):947–54.

    Article  PubMed  Google Scholar 

  30. Patterson SM, Hughes CM, Crealey G, et al. An evaluation of an adapted US model of pharmaceutical care to improve psychoactive prescribing for nursing home residents in Northern Ireland (Fleetwood Northern Ireland study). J Am Geriatr Soc. 2010;58(1):44–53.

    Article  PubMed  Google Scholar 

  31. Child A, Clarke A, Fox C, et al. A pharmacy led program to review anti-psychotic prescribing for people with dementia. BMC Psychiatry. 2012;12:155.

    Article  PubMed Central  PubMed  Google Scholar 

  32. Kuperman GJ, Gibson RF. Computer physician order entry: benefits, costs and issues. Arch Intern Med. 2003;139:31–9.

    Google Scholar 

  33. Kaushal R, Shojania KG, Bates DW. Benefits of computerized physician order entry and clinical decision support systems on medication safety. Arch Intern Med. 2003;163:1409–16.

    Article  PubMed  Google Scholar 

  34. Mattison ML, Afonso KA, Ngo LH, et al. Preventing potentially inappropriate medication use in hospitalized older patients with a computerized provider order entry warning system. Arch Intern Med. 2010;170(15):1331–6.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Drenth-van Maanen AC, van Marum RJ, Knol W, et al. Prescribing optimization method for improving prescribing in elderly patients receiving polypharmacy: results of application to case histories by general practitioners. Drugs Aging. 2009;26(8):687–701.

    Article  PubMed  Google Scholar 

  36. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–34.

    Article  PubMed  Google Scholar 

  37. Bain KT, Holmes HM, Beers MH, et al. Discontinuing medicines: a novel approach for revising the prescribing stage of the medicine use process. J Am Geriatr Soc. 2008;56(10):1946–52.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Muzina DJ. Discontinuing an antidepressant? Tapering tips to ease distressing symptoms. Curr Psych. 2010;9(3):51–61.

    Google Scholar 

  39. Morin CM, Bastien C, Guay B, et al. Randomized clinical trial of supervised tapering and cognitive behavior therapy to facilitate benzodiazepine discontinuation in older adults with chronic insomnia. Am J Psych. 2004;161:332–42.

    Article  Google Scholar 

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Acknowledgments

The authors are grateful to J. D. Baggott for editorial assistance, and to the general practitioners who voluntarily participated in the study: Ana Alvarez, Angelo Forti in collaboration with Myriam Cesaretti, Anna Maria Scotuzzi, Antonio Cartisano, Barbara Ottobri, Emilia Verzeletti, Emma Canossi, Ferdinando Sozzi, Grazia Ventisette, Lorenzo Archetti, Luigi Valenti, Matilde Ferrari, Mauro Zimelli, and Paolo Tanghetti.

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Authors and Affiliations

  1. Pharmacotherapy and Appropriateness of Drugs Prescription Unit, IRCCS-Istituto di Ricerche farmacologiche “Mario Negri”, Via Giuseppe La Masa, 19, 20156, Milan, Italy

    Luca Pasina, Flavio Suardi, Codjo D. Djade, Alessandro Nobili & Carlotta Franchi

  2. Geriatric Unit, Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy

    Alessandra Marengoni & Simona Ghibelli

  3. Brescia Solidale Foundation Nursing Homes, Brescia, Italy

    Gianbattista Guerrini

Authors
  1. Luca Pasina
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  2. Alessandra Marengoni
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  3. Simona Ghibelli
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  4. Flavio Suardi
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  5. Codjo D. Djade
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  6. Alessandro Nobili
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Correspondence to Luca Pasina.

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Funding

No sources of funding were used in the conduct of this study or the preparation of this article.

Conflict of interest

Luca Pasina, Alessandra Marengoni, Simona Ghibelli, Flavio Suardi, Codjo D. Djade, Alessandro Nobili, Carlotta Franchi, and Gianbattista Guerrini have no conflicts of interest that are directly relevant to the content of this manuscript.

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Informed consent was not required for the purpose of this study.

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Pasina, L., Marengoni, A., Ghibelli, S. et al. A Multicomponent Intervention to Optimize Psychotropic Drug Prescription in Elderly Nursing Home Residents: An Italian Multicenter, Prospective, Pilot Study. Drugs Aging 33, 143–149 (2016). https://doi.org/10.1007/s40266-015-0336-z

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  • DOI: https://doi.org/10.1007/s40266-015-0336-z

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