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Reducing Psychotropic Drug Use in Nursing Homes in Belgium: An Implementation Study for the Roll-Out of a Practice Improvement Initiative

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Abstract

Background and Objective

Psychotropic drug use is high in nursing homes in Belgium. A practice improvement initiative (including education, professional support and the transition towards person-centred care) achieved significant reductions in psychotropic drug use. The initiative outline was transcribed into a general intervention template, and consequently implemented in five nursing homes (in mixed locations and with a mixed character) in preparation for a future broader roll-out in Belgium. The impact of the intervention on the use of psychotropic drugs in these five nursing homes is reported in this paper.

Methods

The general intervention template was fitted into the individual nursing home setting. Education for the nursing home personnel on psychotropic drugs and non-pharmacological alternatives, as well as details for a transition to person-centred care was provided. Psychotropic drug use was recorded using a dynamic cohort study design with cross-sectional observations (November 2016–November 2017).

Results

At baseline, participants’ (n = 677) mean age was 85.6 years (range 54–109 years), with 72.6% female. Mean medication intake was 8.5 (range 1–22), predominantly central nervous system drugs (Anatomic Therapeutic Chemical classification N, 88.8%). Long-term (> 3 months) psychotropic drug use (62.0%) and concomitant psychotropic drug use (31.5% taking two or more medications) were high. After 12 months, the prevalence of long-term psychotropic drug use decreased significantly (from 62.0 to 52.9%, p < 0.001), likewise the combined use of psychotropic drugs (from 31.5 to 24.0%, p = 0.001). The decrease in the prevalence of antidepressant and hypnosedative use was significant (respectively, from 32.2 to 23.4%, p < 0.001, and from 35.3 to 28.7%, p = 0.006) in contrast to antipsychotic use (from 17.1 to 15.9%, p = 0.522).

Conclusions

The stand-alone adaptation of the previously reported initiative using a general template was possible. This intervention resulted in a significant decrease in psychotropic drug use (predominantly hypnosedatives and antidepressants) among nursing home residents after 12 months.

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Author notes

  1. Thierry Christiaens and Mirko Petrovic shared last senior authorship.

Authors and Affiliations

  1. Department of Basic and Applied Medical Sciences, Clinical Pharmacology Research Unit, Ghent University, C. Heymanslaan 10, 9000, Ghent, Belgium

    Maarten Wauters, Monique Elseviers & Thierry Christiaens

  2. Centre for Research and Innovation in Care, University of Antwerp, Wilrijk, Belgium

    Monique Elseviers

  3. Nursing Home Leiehome, Drongen, Belgium

    Laurine Peeters & Dirk De Meester

  4. Department of Internal Medicine and Pediatrics, Section of Geriatrics, Ghent University, Ghent, Belgium

    Mirko Petrovic

Authors
  1. Maarten Wauters
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  2. Monique Elseviers
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  3. Laurine Peeters
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  4. Dirk De Meester
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  5. Thierry Christiaens
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Corresponding author

Correspondence to Maarten Wauters.

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Funding

Funding for the conduct of this study was received from the Flemish Agency for Care and Health (Vlaams Agentschap voor Zorg en Gezondheid).

Conflict of interest

Maarten Wauters, Monique Elseviers, Laurine Peeters, Dirk De Meester, Thierry Christiaens and Mirko Petrovic have no conflicts of interest that are directly relevant to the content of this article. The authors received no support from any organisation for the submitted work, have no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced the submitted work.

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Wauters, M., Elseviers, M., Peeters, L. et al. Reducing Psychotropic Drug Use in Nursing Homes in Belgium: An Implementation Study for the Roll-Out of a Practice Improvement Initiative. Drugs Aging 36, 769–780 (2019). https://doi.org/10.1007/s40266-019-00686-5

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  • DOI: https://doi.org/10.1007/s40266-019-00686-5

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