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The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD)
BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are virtually ubiquitous in dementia. Excessive recourse to use of psychotropics which have high risk to benefit ratio remains a global problem. We aimed to identify components of quality prescribing in BPSD to develop a tool for q...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cambridge University Press
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501300/ https://www.ncbi.nlm.nih.gov/pubmed/25642751 http://dx.doi.org/10.1017/S1041610214002816 |
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author | Peisah, Carmelle Strukovski, Julie-Anne Wijeratne, Chanaka Mulholland, Rosalind Luscombe, Georgina Brodaty, Henry |
author_facet | Peisah, Carmelle Strukovski, Julie-Anne Wijeratne, Chanaka Mulholland, Rosalind Luscombe, Georgina Brodaty, Henry |
author_sort | Peisah, Carmelle |
collection | PubMed |
description | BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are virtually ubiquitous in dementia. Excessive recourse to use of psychotropics which have high risk to benefit ratio remains a global problem. We aimed to identify components of quality prescribing in BPSD to develop a tool for quality prescribing and to test this tool. METHODS: We used Delphi methodology to identify elements of quality prescribing in BPSD. The tool was tested by a range of medical and nursing professionals on 48 patients, in inpatient and ambulatory settings in Northern Sydney Local Health District, Australia. RESULTS: Consensual opinion using Delphi method was that quality prescribing in dementia comprised ten factors including failure to use first line non-pharmacological strategies, indication, choice of drug, consent, dosage, mode of administration, titration, polypharmacy, toxicity, and review. These elements formed the quality use of medications in dementia (QUM-D) tool, lower scores of which reflected quality prescribing, with a possible range of scores from 0 to 30. When inter-rater reliability was tested on a subgroup of raters, QUM-D showed high inter-rater reliability. A significant reduction in QUM-D scores was demonstrated from baseline to follow-up, mean difference being 5.3 (SD = 3.8; 95% confidence interval 4.1–6.4; t = 9.5; df = 47; p < 0.001). There was also a significant reduction in score from baseline to follow-up when rated by clinical nurse consultants from a specialized behavior assessment management service (BAMS) (N = 12). CONCLUSION: The QUM-D is a tool which may help to improve quality prescribing practices in the context of BPSD. In this setting, we consider quality prescribing, and accordingly the obligations of prescribers, to be an inclusive concept rather than just adding to the mantra of “not prescribing.” |
format | Online Article Text |
id | pubmed-4501300 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Cambridge University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-45013002015-07-15 The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD) Peisah, Carmelle Strukovski, Julie-Anne Wijeratne, Chanaka Mulholland, Rosalind Luscombe, Georgina Brodaty, Henry Int Psychogeriatr Research Article BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are virtually ubiquitous in dementia. Excessive recourse to use of psychotropics which have high risk to benefit ratio remains a global problem. We aimed to identify components of quality prescribing in BPSD to develop a tool for quality prescribing and to test this tool. METHODS: We used Delphi methodology to identify elements of quality prescribing in BPSD. The tool was tested by a range of medical and nursing professionals on 48 patients, in inpatient and ambulatory settings in Northern Sydney Local Health District, Australia. RESULTS: Consensual opinion using Delphi method was that quality prescribing in dementia comprised ten factors including failure to use first line non-pharmacological strategies, indication, choice of drug, consent, dosage, mode of administration, titration, polypharmacy, toxicity, and review. These elements formed the quality use of medications in dementia (QUM-D) tool, lower scores of which reflected quality prescribing, with a possible range of scores from 0 to 30. When inter-rater reliability was tested on a subgroup of raters, QUM-D showed high inter-rater reliability. A significant reduction in QUM-D scores was demonstrated from baseline to follow-up, mean difference being 5.3 (SD = 3.8; 95% confidence interval 4.1–6.4; t = 9.5; df = 47; p < 0.001). There was also a significant reduction in score from baseline to follow-up when rated by clinical nurse consultants from a specialized behavior assessment management service (BAMS) (N = 12). CONCLUSION: The QUM-D is a tool which may help to improve quality prescribing practices in the context of BPSD. In this setting, we consider quality prescribing, and accordingly the obligations of prescribers, to be an inclusive concept rather than just adding to the mantra of “not prescribing.” Cambridge University Press 2015-08 2015-02-02 /pmc/articles/PMC4501300/ /pubmed/25642751 http://dx.doi.org/10.1017/S1041610214002816 Text en © International Psychogeriatric Association 2015 This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Peisah, Carmelle Strukovski, Julie-Anne Wijeratne, Chanaka Mulholland, Rosalind Luscombe, Georgina Brodaty, Henry The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD) |
title | The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD) |
title_full | The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD) |
title_fullStr | The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD) |
title_full_unstemmed | The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD) |
title_short | The development and testing of the quality use of medications in dementia (QUM-D): a tool for quality prescribing for behavioral and psychological symptoms of dementia (BPSD) |
title_sort | development and testing of the quality use of medications in dementia (qum-d): a tool for quality prescribing for behavioral and psychological symptoms of dementia (bpsd) |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4501300/ https://www.ncbi.nlm.nih.gov/pubmed/25642751 http://dx.doi.org/10.1017/S1041610214002816 |
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