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Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial

BACKGROUND: antipsychotic drugs are regularly prescribed as first-line treatment for neuropsychiatric symptoms in persons with dementia although guidelines clearly prioritise non-pharmacological interventions. OBJECTIVE: we investigated a person-centred care approach, which has been successfully eva...

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Autores principales: Richter, Christin, Berg, Almuth, Langner, Henriette, Meyer, Gabriele, Köpke, Sascha, Balzer, Katrin, Wolschon, Eva-Maria, Silies, Katharina, Sönnichsen, Andreas, Löscher, Susanne, Haastert, Burkhard, Icks, Andrea, Wolf, Ursula, Fleischer, Steffen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503937/
https://www.ncbi.nlm.nih.gov/pubmed/30806453
http://dx.doi.org/10.1093/ageing/afz016
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author Richter, Christin
Berg, Almuth
Langner, Henriette
Meyer, Gabriele
Köpke, Sascha
Balzer, Katrin
Wolschon, Eva-Maria
Silies, Katharina
Sönnichsen, Andreas
Löscher, Susanne
Haastert, Burkhard
Icks, Andrea
Wolf, Ursula
Fleischer, Steffen
author_facet Richter, Christin
Berg, Almuth
Langner, Henriette
Meyer, Gabriele
Köpke, Sascha
Balzer, Katrin
Wolschon, Eva-Maria
Silies, Katharina
Sönnichsen, Andreas
Löscher, Susanne
Haastert, Burkhard
Icks, Andrea
Wolf, Ursula
Fleischer, Steffen
author_sort Richter, Christin
collection PubMed
description BACKGROUND: antipsychotic drugs are regularly prescribed as first-line treatment for neuropsychiatric symptoms in persons with dementia although guidelines clearly prioritise non-pharmacological interventions. OBJECTIVE: we investigated a person-centred care approach, which has been successfully evaluated in nursing homes in the UK, and adapted it to German conditions. DESIGN: a 2-armed 12-month cluster-randomised controlled trial. SETTING: nursing homes in East, North and West Germany. METHODS: all prescribing physicians from both study arms received medication reviews for individual patients and were offered access to 2 h of continuing medical education. Nursing homes in the intervention group received educational interventions on person-centred care and a continuous supervision programme. Primary outcome: proportion of residents receiving at least one antipsychotic prescription after 12 months of follow-up. Secondary outcomes: quality of life, agitated behaviour, falls and fall-related medical attention, a health economics evaluation and a process evaluation. RESULTS: the study was conducted in 37 nursing homes with n = 1,153 residents (intervention group: n = 493; control group: n = 660). The proportion of residents with at least one antipsychotic medication changed after 12 months from 44.6% to 44.8% in the intervention group and from 39.8 to 33.3% in the control group. After 12 months, the difference in the prevalence was 11.4% between the intervention and control groups (95% confidence interval: 0.9–21.9; P = 0.033); odds ratio: 1.621 (95% confidence interval: 1.038–2.532). CONCLUSIONS: the implementation of a proven person-centred care approach adapted to national conditions did not reduce antipsychotic prescriptions in German nursing homes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02295462.
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spelling pubmed-65039372019-05-09 Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial Richter, Christin Berg, Almuth Langner, Henriette Meyer, Gabriele Köpke, Sascha Balzer, Katrin Wolschon, Eva-Maria Silies, Katharina Sönnichsen, Andreas Löscher, Susanne Haastert, Burkhard Icks, Andrea Wolf, Ursula Fleischer, Steffen Age Ageing Research Paper BACKGROUND: antipsychotic drugs are regularly prescribed as first-line treatment for neuropsychiatric symptoms in persons with dementia although guidelines clearly prioritise non-pharmacological interventions. OBJECTIVE: we investigated a person-centred care approach, which has been successfully evaluated in nursing homes in the UK, and adapted it to German conditions. DESIGN: a 2-armed 12-month cluster-randomised controlled trial. SETTING: nursing homes in East, North and West Germany. METHODS: all prescribing physicians from both study arms received medication reviews for individual patients and were offered access to 2 h of continuing medical education. Nursing homes in the intervention group received educational interventions on person-centred care and a continuous supervision programme. Primary outcome: proportion of residents receiving at least one antipsychotic prescription after 12 months of follow-up. Secondary outcomes: quality of life, agitated behaviour, falls and fall-related medical attention, a health economics evaluation and a process evaluation. RESULTS: the study was conducted in 37 nursing homes with n = 1,153 residents (intervention group: n = 493; control group: n = 660). The proportion of residents with at least one antipsychotic medication changed after 12 months from 44.6% to 44.8% in the intervention group and from 39.8 to 33.3% in the control group. After 12 months, the difference in the prevalence was 11.4% between the intervention and control groups (95% confidence interval: 0.9–21.9; P = 0.033); odds ratio: 1.621 (95% confidence interval: 1.038–2.532). CONCLUSIONS: the implementation of a proven person-centred care approach adapted to national conditions did not reduce antipsychotic prescriptions in German nursing homes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02295462. Oxford University Press 2019-05 2019-02-26 /pmc/articles/PMC6503937/ /pubmed/30806453 http://dx.doi.org/10.1093/ageing/afz016 Text en © The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Research Paper
Richter, Christin
Berg, Almuth
Langner, Henriette
Meyer, Gabriele
Köpke, Sascha
Balzer, Katrin
Wolschon, Eva-Maria
Silies, Katharina
Sönnichsen, Andreas
Löscher, Susanne
Haastert, Burkhard
Icks, Andrea
Wolf, Ursula
Fleischer, Steffen
Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial
title Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial
title_full Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial
title_fullStr Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial
title_full_unstemmed Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial
title_short Effect of person-centred care on antipsychotic drug use in nursing homes (EPCentCare): a cluster-randomised controlled trial
title_sort effect of person-centred care on antipsychotic drug use in nursing homes (epcentcare): a cluster-randomised controlled trial
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503937/
https://www.ncbi.nlm.nih.gov/pubmed/30806453
http://dx.doi.org/10.1093/ageing/afz016
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